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Erectile dysfunction treatment consultation

To place an order, fill out the consultation questionnaire correctly.
One of our clinicians will review your order and prescribe a suitable treatment.
You will only be charged if treatment is prescribed.

ED Consultation

You
Medical
Your details
Select product

Your details

Please provide us with accurate details as our prescriber might need to access your GP record and you are consented to access your Summary Care Record (SCR). This is necessary for the safe and best treatment of your conditions.

First Name

Last Name

Date of birth

Address

City

Post Code

Email

Mobile

About you

1. What is your gender?

2. Do you have/have you had any medical problems or operations? For example, neurological problems (e.g. Parkinson's, previous stroke or mini-stroke)?. hormone or sugar problems (e.g. diabetes, thyroid problems)?, kidney problems?, breathing problems (e.g. asthma, COPD, bronchiectasis)?, liver problems (e.g. hepatitis, fatty liver, alcohol liver disease)?, mental health problems (e.g. anxiety, depression, personality disorder)? or any other diagnosed conditions?

Yes

No

Please provide more information

3. Are you taking any medications (prescription, over the counter or herbal)?

Yes

No

Please provide more information

4. Are you allergic to any medication, food or any other substances?

Yes

No

Please provide more information

5. Do you take any recreational drugs?

Yes

No

Please provide more information

6. What is your blood pressure?

Normal - 90/60 to 139/89

High - 140/90 or above

Low - below 90/60

7. Do you drink alcohol?

Yes

No

How many units of alcohol per week

8. Do you smoke?

Yes

No

Please read about the NHS smoking cessation help. We also offer a stop smoking service via our online doctor.

Medical

The answers you provide to the questions will be reviewed by a UK registered prescriber to help us better understand and treat your condition. All information will be handled with the utmost discretion and confidentiality, so please be honest with your answers, including any current medication you are on.

1. Do you persistently have difficulty getting and maintaining an erection?

Yes

No

Please provide more information:

2. Are you taking nicorandil or any nitrate medication?

Yes

No

There can be a fatal reaction between erectile dysfunction medication and these medicines. Please contact your regular GP.

Please provide more information:

3. Do you suffer from any condition affecting the shape of your penis?

Yes

No

Please provide more information:

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

Yes

No

Please provide more information:

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

Yes

No

Please provide more information:

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

Yes

No

Please provide more information:

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

Yes

No

Please provide more information:

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

Yes

No

Please provide more information:

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

Yes

No

Please provide more information:

Consent

I agree not to take any other ED medications at the same time, I understand that in the event of a continuous erection for 4 hours or more I should seek immediate medical advice

I consent to have OnlineChemist store my submitted information so they can respond to my inquiry

I have read and agree to the Terms and Conditions and Privacy Policy

Prescription (official use only)

Experiences Shared by Our Customers

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Online Chemist in Gorleston, an NHS online pharmacy and travel vaccine clinic

Online Chemist
82 Middleton Road
Gorleston
Great Yarmouth
Norfolk, NR31 7AH
Phone: 01493 600610
Email: info@onlinechemistuk.net

Superintendent Pharmacist:
Obaidullah Zaman
BPharm, MPharm, PGDip (Pharmacy), MRPharmS, IP
GPhC Reg. Number: 2083409

Pharmacy Premises GPhC Reg. Number: 9011159

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NHS online pharmacy Gorleston Great Yarmouth Norfolk

OPENING HOURS

Monday 09:00 – 17:00
Tuesday 09:00 – 17:00
Wednesday 09:00 – 17:00
Thursday 09:00 – 17:00
Friday 09:00 – 17:00
Saturday Closed
Sunday Closed

Click here for driving directions

Online Chemist is a trading name of Nomaz Limited.
Registered in England – 11349276.

© 2024 All rights reserved.

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