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Online Appointments
- - Online Appointments - Coming Soon!
  GPs
- Psychologists
- - Frequently Asked Questions
    View all
  FAQ
- - Why choose Simple Online Doctor
    
    Our AHPRA registered health professionals are online and ready to help
    
    Australian Registered
    
    Convenient
    
    Easy to use
  Why Us
- - How it Works
    
    Make Appointment
    
    Make an appointment with one of our health experts for an online video consultation
    
    Information
    
    Complete a form to give us some information about why you want to chat to a doctor, and complete payment for your appointment
    
    Get Online
    
    Just be online at the correct time, and start your online consultation with one of our GPs
    
    Find Out More
  How It Works
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Medications
FAQs

Assessment Progress

1About You
2Your Health
3Acknowledgements
4Consent

Assessment

Ordered Before? Log in now, and save time completing your assessment and confirm you have verified your ID.

Item added to bag. Click here to view bag.

Please select a size from above to proceed.

There are NHS prescriptions in your basket. Please complete the order first or remove NHS prescriptions from the basket.

Patient Notice!

This questionnaire forms the basis of your erectile dysfunction consultation today. You are required to be honest with your answers include any current medication you are on.

1About You

Have you previously been prescribed your selected medication by your regular GP? *

No Yes

Unfortunatley we can not issue a script for this medication.

You should see your regular GP for initial diagnosis and prescribing.

Do you persistently have difficulty getting and maintaining an erection? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Note: If your ED symptoms are only occassional, you may find that counselling may help. You can discuss options with your GP.

Are you male and aged between 18-70?

Note: You must enter your own name and address on the check out page for prescription purposes. Orders placed with womens' names, are likely to be refunded or delayed, until follow up contact is made to confirm identity. *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

2Your Health

Are you taking Nicorandil or any Nitrate medication?

This includes any sprays, patches, gels or creams.

WARNING: There can be a fatal reaction between ED medication and these medications *

No Yes

WARNING: FATAL REACTION; There can be a fatal reaction between ED tablets and nitrate medications such as GTN spray. You must not take or purchase ED medication from us if you take Nicorandil, a GTN spray, tablets, patch, gel or cream or any nitrate tablets (usually for heart conditions). You MUST see your regular GP to discuss alternative options.

Are you taking any prescription medication? *

No Yes

Are you taking any of the following prescription medicines? Alfuzosin | Doxazosin | Tamsulosin | Terazosin | Flomax***Any other alpha-blockers used for high blood pressure or prostate issues****- Any beta-blockers used for heart conditions: high blood pressure, anxiety etc ***- Isosorbide dinitrate | isosorbide mononitrate | Nicorandil | Rectogesic ***- GTN spray tablets or cream ***- Any other nitrate-containing medicines ***- Any diuretics or water used for high blood pressure, heart and kidney problems *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Please list any other prescription medicines you are taking *

Are you circumcised? *

No Yes

Do you have trouble retracting your foreskin fully when your penis is erect? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Do you suffer from angina, aortic stenosis, hypertrophic obstructive cardiomyopathy, uncontrolled blood pressure, arrhythmia, or severe heart disease? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Have you had a heart operation, heart attack or a stroke in the last six months? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Do you suffer from low blood pressure, faints or collapses? Low blood pressure is less than 90 / 50. If you are unsure, check with your GP or local pharmacy *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Do you suffer from high blood pressure? High blood pressure is higher than 160 / 90. If you are unsure, check with your GP or local pharmacy *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Have you been advised to avoid strenuous exercise, or do you have difficulty in walking for more than 5 minutes at a fast pace? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Have you ever had any problems with your kidneys, urinary system or with your liver? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Do you have any eye problems, such as hereditary degenerative retinal disorders or macular degeneration? *

No Yes

Unfortunately you are not eligible for Erectile Dysfunction Treatment. Please discuss treatment options with your GP

Have you ever been diagnosed with diabetes or abnormal blood sugar levels? *

No Yes

Please give more details *

Do you have any known allergies? *

No Yes

Please give more details

Is your Body Mass Index (BMI) above 30? Use this URL to find out: http://www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx *

No Yes

Overweight men are more liklely to suffer from erectile dysfunction (ED)

You may want to consider losing weight to see if this helps improve your symptoms.

Do you smoke? *

No Yes

Please be aware that smoking can be a factor in erectile dysfunction. It is advised you try to reduce your smoking, particularly if smoking more than 20 cigarettes per day

Do you often drink more than 21 units of alcohol per week? *

No Yes

Note: Heavy drinkers have more erectile dysfunction problems. Consider reducing your alcohol intake to see if this improves your ED.

3Acknowledgements

Are you aware you should not take any combination of ED medications at the same time? *

No Yes

You should never take combinations of ED medicatoins at the same time.

Breaks of 24 hours, or 36 hours for Cialis and Tadalafil, should be left between medication.

Our doctors are unable to prescribe more than one type of ED medication.

Orders with more than one type of ED medication will be refunded.

I understand if I have a continuous erection for 4 hours or more I should seek immediate medical advice? *

Confirm

4Consent

We strongly advise that you inform your GP of any treatment you receive.
Would you like us to inform them on your behalf? If you are unsure, you can search your GP clinic information by clicking here.

*

No Yes

Please enter the email address of your GP clinic *

I confirm I am a male over 18 years old.

The medicine ordered is for my sole use only.

I will read the patient information leaflet supplied with the medicine specifically the side effects and dosages.

I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances.

I agree to the Simple Online Doctor terms and conditions. *

Confirm

Please Note: You are unable to purchase this medication on behalf of anyone else. The patient's name is needed for prescription purposes. You can enter this on the checkout page. Failure to do so, may result in delay to your assessment.

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