Consultation
Cart
Delivery
Payment

Medical Assessment

Ordered treatment before? Log in now to check out faster.

About You
Are you male and aged between 18-75?
    We are unable to supply you with medication for erectile dysfunction. Please consult your GP or doctor.
    Please complete this question.
    Do you smoke or drink?
    You are eligible for treatment, however, be aware that consuming alcoholic drinks and/or smoking can make erectile dysfunction worse.
    Please complete this question.
    Have you taken Viagra (sildenafil), Levitra (vardenafil), Nipatra, Spedra or Cialis (tadalafil) at least 4 times previously without any side effects?
    As you have not previously taken any erectile dysfunction medication, we will not be able to supply you with a high-strength treatment. You must try a standard-strength treatment at least 4 times to be eligible for a high-strength treatment.
    Please complete this question.
    Your Symptoms
    Do you have trouble achieving or maintaining your erection?
      It does not appear that you have erectile dysfunction. We are unable to supply you with treatment. Please consult your GP or doctor for more information.
      Please complete this question.
      Your Health
      Do you have any allergy to Viagra (sildenafil), Levitra (vardenafil), Spedra (avanafil) or Cialis (tadalafil) or have you experienced any adverse reaction to any erectile dysfunction medication previously?
        We are unable to supply you with treatment. Please consult your GP or doctor for more information.
        Please complete this question.
        Do you have high blood pressure (above 160/90), or are you currently on treatment for high blood pressure?
        • If you do not know your blood pressure you can have this measured at your local pharmacy/GP surgery.
        We are unable to supply you with treatment if you have high blood pressure. Please consult your GP or doctor for more information.
        Please complete this question.
        Do you have low blood pressure (below 90/50)?
        • If you do not know your blood pressure you can have this measured at your local pharmacy/GP surgery.
        We are unable to supply you with treatment if you have low blood pressure. Please consult your GP or doctor for more information.
        Please complete this question.
        Do you suffer from depression for which you have not seen a GP?
          We are unable to supply you with treatment at this time. Please consult your GP or doctor for more information.
          Please complete this question.
          Have you been advised to avoid strenuous exercise?
            We are unable to supply you with treatment. Please consult your GP or doctor for more information.
            Please complete this question.
            Have you ever suffered from any of the problems listed below?
            • Any heart problems including angina, chest pain, heart failure, irregular heartbeats, heart attack (myocardial infarction), left-ventricular outflow obstruction, cardiomyopathy or valvular heart disease (e.g.aortic stenosis)
            • Stroke
            • Sight loss due to poor circulation
            • Sight loss because of non-arteritic anterior ischemic optic neuropathy (NAION)
            • Blood problems such as haemophilia, sickle cell anaemia (an abnormality of red blood cells), leukaemia (cancer of blood cells)
            • Stomach ulcers (e.g. peptic/gastric ulcer)
            • Liver problems
            • Kidney problems
            • An erection that lasted more than 4 hours
            • Any physical condition affecting the shape of the penis (e.g. angulation, Peyronie’s disease and cavernosal fibrosis)
            • Inherited eye disease - retinitis pigmentosa
            • Multiple myeloma (cancer of the bone marrow)
            • Galactose intolerance, Lapp Lactase deficiency or glucose-galactose malabsorption
            • Any serious medical condition which may require immediate hospitalisation
            We are unable to supply you with treatment. Please consult your GP or doctor for more information.
            Please complete this question.
            Would you have any difficulty walking at a fast pace for 5 minutes?
              We are unable to supply you with treatment at this time. Please consult your GP or doctor.
              Please complete this question.
              Your Medication
              Are you currently taking any medication (over-the-counter or prescription) or any recreational drugs?
              Are you taking any of the following?
              • Any other erectile dysfunction treatments that are not Viagra (sildenafil), Levitra (vardenafil), Cialis (tadalafil), Spedra (avanafil)
              • Medicinal nitrates such as glycerol trinitrate, isosorbide mononitrate or isosorbide dinitrate (including oral, transdermal and sublingual)
              • Recreational drugs prohibited by law (Class A, B or C)
              • Recreational nitrates such as amyl nitrate also known as "poppers"
              • Alpha-blockers (used to treat high blood pressure or urinary symptoms associated with benign prostatic hyperplasia, including tamsulosin, doxazosin, prazosin, terazosin & indoramin)
              • Medicines to treat high blood pressure
              • Warfarin - used prevent heart attacks, strokes, and blood clots
              • Antivirals including (Atazanavir, etravirine, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir)
              • Nicorandil
              • Anti-fungal medication such as ketoconazole or itraconazole
              • Quinidine/procainamide/amiodarone
              • Theophylline
              • Erythromycin/clarithromycin/cimetidine
              • Phenobarbital, phenytoin and carbamazepine (anticonvulsant medicines)
              • Riociguat
              • Rifampicin
              We are unable to supply you with treatment. Please consult your GP or doctor for more information.
              Please complete this question.
              Are you taking any medicines known as nitrates (often taken for chest pain/angina) or nitric oxide donors ('poppers')?
              • Often taken for chest pain/angina
              • Can be administered as a spray, tablet or patch
              • Includes glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate
              We do not advise any recreational drug use with PDE 5 inhibitors, especially nitric oxide donors such as ‘poppers’ which may lead to a dangerous fall in your blood pressure. We are unable to supply you with treatment. Please consult your GP or doctor for more information.
              Please complete this question.
              Agreement
              Do you understand that erectile dysfunction can be associated with a number of contributing health conditions e.g. hypertension, diabetes mellitus, high cholesterol or cardiovascular disease and you should consult your doctor within 6 months of starting treatment for a clinical review?
                You must agree to this before continuing. If you need assistance, please contact our customer support.
                Please complete this question.
                In the rare event, I obtain a prolonged erection of more than 4 hours or experience any sudden visual impairment, I agree that I will seek immediate medical assistance.
                  You must agree to this before continuing. If you need assistance, please contact our customer support.
                  Please complete this question.
                  Do you agree to the following?
                  • 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, you start new medication and/or 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
                  • You understand that whilst decisions relating to your treatment are made jointly between you and the prescriber, the final decision to issue a prescription will always be with the prescriber
                  You must agree to this before continuing. If you need assistance contact our customer support.
                  Please complete this question.
                  Complete our 2 minute questionnaire
                  We’re almost done!
                  Ana Carolina Osorio De Faria Goncalves
                  To find a treatment suitable for you, we just need you to answer a few questions.
                  Ana Carolina Goncalves
                  Superintendent Pharmacist
                  Confidential & Secure
                  • We will review your details in complete confidence
                  • Your medication will be delivered in plain unlabelled packaging
                  • Appears on your statement as "Pharma"
                  • All data is securely encrypted with 256-bit SSL
                  Lowest Price Guarantee

                  We're so confident you won't find your treatment cheaper, that if you do, we'll refund the difference for up to 14 days!

                  Need help?

                  If you need help with this medical assessment, contact our helpline:

                  0207 112 9014

                  or email us:

                  help@pharmica.co.uk
                  Fully Regulated

                  We are regulated by the General Pharmaceutical Council

                  Online Pharmacy Logo View GPhC Registration