Online Consultation for Erectile Dysfunction Treatment

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Is this treatment for you?

Yes

This question is required and must be answered.

Diagnosis and Previous Treatments

Do you have trouble getting or keeping an erection hard enough for sex? This may happen every time, or just sometimes.

Yes

This question is required and must be answered.

Have you experienced erectile dysfunction that you believe is related to anxiety or stress?

Yes

This question is required and must be answered.

Have you used any medication for erectile dysfunction before?

Yes

This question is required and must be answered.

Important Note: We cannot prescribe any injectable ED medication until you have had training from a Healthcare Professional

If ordering injectable medication eg Caverject have you used this type of treatment before? (if not ordering please answer NO)

Yes

This question is required and must be answered.

If ordering injectable medication eg Alprostadil / Viridal have you had training to safely use this injection? (if not ordering please answer NO)

If you have NOT had any training then please do not place an order until you have contacted us for more information about this.

Yes

This question is required and must be answered.

Medical History

Do you take any medication, or have any medical conditions?

Yes

This question is required and must be answered.

Do you have high or low blood pressure?

Yes

This question is required and must be answered.

Do you have any liver or kidney problems including reduced kidney function or chronic liver disease?

Yes

This question is required and must be answered.

Do you drink alcohol?

Yes

This question is required and must be answered.

Do you have any known allergies? E.g. Penicillin, egg protein or peanuts or an allergy to the ingredients in some medication eg lactose?

Yes

This question is required and must be answered.

Do you have a condition where sexual intercourse is not advised (i.e. any severe heart disorders such as unstable angina or severe cardiac failure)?

Yes

This question is required and must be answered.

Do you have a hereditary degenerative retinal disorder such as retinitis pigmentosa,

suffer from Non-arteritic anterior ischaemic optic neuropathy (NAION) or

previously had symptoms of sudden vision loss?

Yes

This question is required and must be answered.

Are you taking any HIV medication like protease inhibitor eg Ritonavir or Are you taking Saquinavir, Erythromycin, Ketoconazole or Itraconazole (please double check any medication bottles/packs that you may have).

Yes

This question is required and must be answered.

Are you taking amyl nitrate (poppers), Nicorandil, Isosorbide Mononitrate / Dinitrate tablets or using a GTN (Glyceryl Trinitrate) Spray for angina?

Yes

This question is required and must be answered.

Do you suffer from Peyronie's Disease or have any other physical abnormality of the penis?

Yes

This question is required and must be answered.

Confirmations and Consent

Do you have any disabilities or special needs that we should be aware of, in order to provide you with the best possible care?

For Example: ADHD, ASD or Learning Difficulties. This will help our clinicians and pharmacy team to allow you access all our services safely.

Yes

This question is required and must be answered.

I understand that erectile dysfunction may be an early indicator of diabetes, raised blood pressure or cardiovascular problems. We advise that you should have had blood glucose and cholesterol tests to rule out these health problems. Test kits are available from Oxford Online Pharmacy or visit your GP.

Yes, I confirm

This question is required and must be answered.

Do you give us permission to inform your NHS surgery, about this prescription?

Yes

It is important to tell your doctor of any medication you have been prescribed for them to be able to treat you appropriately, safely and to avoid any drug interactions.

Important Consent Confirmation

By providing us with your details you confirm that you have read, understood and agreed to the legal terms and you consent to the sharing of your data to use our service.

I consent to treatment and an identity check as outlined in our Privacy Policy

I agree to read the patient information leaflet and any other information about the medication provided by Oxford Online Pharmacy

Yes, I confirm

This question is required and must be answered.

Accessing your Health Records held by the NHS

I give consent for the pharmacist to access and store relevant information from my NHS summary care record which may be needed to safely prescribe.

We will only record relevant information in your medical record - please see our Privacy Policy for more information

Yes, I confirm

This question is required and must be answered.

Online Consultation for Erectile Dysfunction Treatment

Start a new Consultation

Diagnosis and Previous Treatments

Medical History

Confirmations and Consent

Surgery Search

Surgery Selected