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What is your current age?
YesNo
Do you currently smoke or use any tobacco products?
How often do you consume alcohol?
How long have you been experiencing difficulties with erections?
Do you struggle to get or maintain an erection?
Do your symptoms occur occasionally, or are they persistent?
Have you used any treatments for erectile dysfunction before? If so, which ones?
Have you ever been diagnosed with a heart condition, such as angina, arrhythmia, or a previous heart attack?
Do you have high or low blood pressure?
Have you been diagnosed with diabetes or high cholesterol?
Do you suffer from any neurological disorders like Parkinson’s disease or multiple sclerosis?
Have you ever had surgery related to your reproductive or urinary system?
Are you currently dealing with stress, anxiety, or depression?
Are you currently taking any prescribed medications? If yes, please list them.
Are you using any over-the-counter medications or herbal supplements?
Are you currently taking nitrate-based medications for heart conditions?
Are you on any alpha-blockers for prostate issues or high blood pressure?
Do you engage in regular physical activity?
How would you describe your usual diet?
Do you experience any sleep disturbances or disorders?
Do you understand that erectile dysfunction medication should be taken as prescribed and may have potential side effects?
Are you aware that ED treatments can interact with certain medications and may not be suitable for everyone?
Do you acknowledge that you should seek medical advice if you experience side effects or if the medication does not work for you?