Before you begin: your answers are reviewed by a UK-registered prescriber and kept confidential. Please answer honestly and in full — it's what keeps your treatment safe. Do you understand and agree to answer honestly?
What is your sex registered at birth?

ED medicines (PDE5 inhibitors) are licensed for men.

How old are you?
Do you smoke?

Smoking and alcohol can both make erection problems worse.

How many units of alcohol do you drink per week?
Do you have difficulty getting or keeping an erection firm enough for sex?
Did your difficulties come on gradually, or suddenly?

Sudden onset can sometimes point to a cause worth discussing with the prescriber.

Do you still get erections at other times — for example on waking, or during masturbation?
Are you allergic to, or have you ever reacted badly to, any ED medicine (sildenafil/Viagra, tadalafil/Cialis, vardenafil/Levitra, avanafil/Spedra)?
How is your blood pressure?

You can get a free blood-pressure check at most pharmacies or your GP surgery.

Do you have depression or low mood that you have not yet seen a doctor about?
Have you been advised to avoid strenuous activity, or would you struggle to walk briskly for 5 minutes or climb two flights of stairs?

Sex is physical activity, so the prescriber needs to know your heart can manage moderate exertion.

Have you ever been diagnosed with any of the following?
Are you currently taking any medicines (prescription or over-the-counter), supplements, or recreational drugs?
Do you take any nitrate medicine (for chest pain or angina), or use poppers (amyl nitrite)?

Nitrates include GTN spray/tablets and isosorbide mononitrate/dinitrate. Taken with ED medicines, nitrates or poppers can cause a dangerous drop in blood pressure.

Are you taking any of these?

If you take amiodarone, phenytoin, carbamazepine, rifampicin, bosentan or theophylline, please also list it in the medicines box above.

Have you used ED treatment before, or is this your first time?
Have you taken an ED medicine (sildenafil, tadalafil, vardenafil or avanafil) at least 4 times before without any problems?

A higher-strength treatment is only suitable once you've safely used a standard strength at least 4 times.

Which ED medicine have you used?
Did you have any side effects with it?
Which treatment are you interested in?

The prescriber confirms what's suitable and the right strength for you.

You understand that ED can be linked to underlying conditions (high blood pressure, diabetes, raised cholesterol or heart disease), and that you should see your doctor within 6 months of starting for a check-up. Do you understand?
You understand that if you get an erection lasting more than 4 hours, or any sudden change in your vision or hearing, you must seek emergency medical help. Do you understand?
You understand you must not use poppers or recreational nitrates while taking ED medicine, as the combination can cause a dangerous fall in blood pressure. Do you understand?
Is there anything else you'd like to tell the prescriber?
Please confirm all of the following: you will read the patient information leaflet supplied; the treatment is for your use only; you have answered every question truthfully and accurately; you will tell us and your GP if you get side effects, start new medicines, or your health changes; and you agree to our terms & conditions, privacy policy and acceptable-use policy.
Do you consent to us informing your NHS GP that you have started this treatment?

We think it’s safest to keep your regular GP in the loop about your care. If you don’t consent, we’re unable to continue with this treatment.

Which is your GP practice?

Start typing your surgery name or postcode and pick it from the list.

Can’t find your practice? Enter it manually

Do you agree to OnlineUKPharmacy accessing your GP Summary Care Record if the prescriber needs to?
I understand that if this treatment is not suitable I will be refunded and signposted to appropriate care, and that the final prescribing decision always rests with the prescriber.