To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

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This could be from an examination by your doctor, a certified medical practitioner or self-examination.


You have or have had stomach or duodenal ulcers, as well as stomach or intestinal bleeding in the past.
Your doctor has ever told you that your kidney function is less than 100 percent.
You have previously suffered a terrible reaction to aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).
You want to use Ibuprofen Gel on skin that is fractured, injured, diseased, or infected.

You've had a heart procedure, a stroke, or a heart attack in the last five years.
You have angina, aortic stenosis, heart failure, cardiomyopathy, high blood pressure that is uncontrolled (greater than 160/90), arrhythmia, or severe heart disease.
You have suffered low blood pressure, fainting, or feeling dizzy when you stand up after lying down in the past.
Diabetes (type I or type 2) or blood sugar levels that are abnormal.
Medical diseases that impact the eyes, such as glaucoma or degenerative eye disease, as well as a family history of these conditions.
Peyronie's disease is a deformity or angulation of the penis.
Sickle cell disease, leukemia, or multiple myeloma are all examples of blood cancers.
A disease that causes bleeding

If so, how successful was it?

Antibiotics.
Antihistamines such as stemizole or terfenadine.
Cisapride for stomach discomfort.
Quinidine for circulatory problems.
Pimozide for schizophrenia.

A healthcare practitioner should assess any acute injuries.
You should see your doctor about chronic pain at least once a year.

An erection lasting more than 4 hours.
Vision is hazy.
One or both eyes have a sudden decline or loss of vision.
Pain in the chest.

Please select your option
Male
Female
Transmale (Born a female)
Transfemale (Born a male)

Please select your option
Presently Pregnant
Presently Breastfeeding
Planning on getting pregnant
Neither Pregnant nor Breastfeeding

Please provide more information of the medication being used if any.

You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

If so, how successful was it?


It is never a good idea to self-diagnose and treat urine incontinence.
At the very least, you should see your doctor for a checkup once a year.
You must follow your doctor's instructions for any treatment.
You should only order repeat supplies of medicines that your doctor has prescribed.

If you did, kindly describe the effects

You can select one or more options
Viagra
Cialis
Levitra
Spedra
I've never used any ED medication before.

Do you require assistance?

This may have been by your GP or another healthcare professional, or by taking your own blood pressure on a home monitor.

Do you have an allergy to Sildenafil, Tadalafil or Vardenafil

Have you taken either Sildenafil, Tadalafil or Vardenafil


If yes, please describe the product/reaction.

If yes, please provide details

If yes, please provide the reason

Heart disease, heart attack, angina (chest pain during exertion), stroke, mini-stroke (transient ischaemic attack), sight loss due to poor circulation, inherited eye disease – retinitis pigmentosa, severe kidney or liver disease, deformity of the penis (e.g. Peryonie’s Disease), painful erections, sickle cell disease / leukaemia / multiple myeloma, bleeding conditions (e.g. haemophilia), stomach ulcers (e.g. gastric/peptic ulcer)


If yes, please provide details


If yes, please provide details


If yes, please provide details





Please answer the following questions to help us confirm that you'll follow the guidelines for this medicine.

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You will read the patient information leaflet supplied with your medication
You will contact us and inform your GP of your medication if you experience any side effects of treatment, if you start new medication or if your medical conditions change during treatment.
The treatment is solely for your own use
You have answered all the above questions accurately and truthfully. You understand our prescribers take your answers in good faith and base their prescribing decisions accordingly, and that incorrect information can be hazardous to your health.