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?

Dapoxetine is licensed for men.

How old are you?
Do you drink alcohol?

Alcohol with dapoxetine can increase drowsiness and the risk of fainting, so it's best avoided around the time you take it.

Do you regularly ejaculate sooner than you would like, with little control over the timing?
Does ejaculation usually happen within about 1–2 minutes of penetration?
Has this been the case for most of your life, or did it start more recently?

A recent change can occasionally point to another cause worth discussing.

Have you had this problem for more than 6 months?
Do you have any pain when ejaculating, or pain or difficulty passing urine?
Does premature ejaculation cause you, or your partner, distress or difficulty in your relationship?
Are you allergic to, or have you ever reacted badly to, dapoxetine (Priligy)?
Do you tend to feel faint or light-headed when you stand up from lying or sitting?
How is your blood pressure?

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

Are you currently having thoughts of harming yourself, or that life is not worth living?
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?
Are you taking any of these?

If you take aprepitant or any other medicine not listed, please add it in the medicines box above.

Do you also have difficulty getting or keeping an erection?

Dapoxetine does not treat erection problems; if both are present the prescriber will usually address the erection problem first.

Have you used PE treatment before, or is this your first time?
Have you taken dapoxetine 30mg at least 4 times without side effects and found it wasn't strong enough?

The higher 60mg strength is only suitable once you've safely tried 30mg at least 4 times — the lower strength works well for many men with fewer side effects.

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 if you notice changes in your mood, distressing thoughts, or any seizures, you must stop treatment immediately and seek urgent medical help. Do you understand?
You understand that if you feel light-headed after standing, you should sit or lie down (head lower than the body) until it passes, get up slowly after lying or sitting, and not drive or operate machinery if affected. Do you understand?
You understand that dapoxetine does not treat erectile dysfunction, and that taking it together with ED medicines is not recommended because it can lower your 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.