We'll be asking a few questions so your doctor can find the best treatment for you. This quiz is short and sweet, and confidential between you and your doctor.
Please make sure your email address is correct
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Please Provide Your Valid phone Number
By providing your phone number, you are giving us permission to reach you through SMS or WhatsApp.
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Generally, how often do you intend to have intercourse?
Reqularly (at least twice weekly)
Weekly
Every couple of weeks/less often
Do you think there could be psychological causes for your erectile dysfunction?
E.g., anxiety or depression
No
Yes
Please explain the psychological causes for your doctor.
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Do you ever have a problem getting or maintaining an erection that's hard and satisfying enough for sex?
Yes, every time
Yes, more then half the time
Yes, on occasion
I never have a problem
Do you ever get an erection?
For example in the mornings or when you masturbate.
No
Yes
Have you ever seen a specialist about your condition?
No
Yes
Please explain.
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Have you ever taken or used any medications, supplements or herbs for erectile dysfunction before?
No
Kind of, I've dabbled
Yes
Do you suffer from any of these?
Select any that apply.
None
Peyronie's disease (a curve in the penis that interfares with Sex
Painful erections or ejaculation
Foreskin that is too tight
Any other abnormality of the penis
Please explain your condition for your doctor.
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Are you allergic to any medication? Do you have any other allergies?
No
Yes
Please list what you are allergic to and the reaction that each one causes.
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Have you now or in the past ever suffered or been treated for any other medical conditions?
No
Yes
Have you had any cardiovascular (Heart) problems or a heartstroke?
No
Yes
Please explain this for your doctor.
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Are you looking for a specific treatment?
Whatever doctor recommends
Yes
No
What treatment are you looking for?
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Do you ever experience any of the following symptoms when passing urine?
Select any that apply.
None
Problems with starting or stopping your stream
Going more than you use to, especially at night
Interrupted stream - stopping/starting/dribbling
Urge to go more often and less ability to hold on
Others
What is your date of birth?
/
/
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How tall are you?
in Inches.
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How much do you weigh?
in killograms.
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How often do you exercise?
3-5 time per week
2-3 time per week
Once a week
Not a priority
Do you smoke, vape or use tobacco?
No
Yes
Do you want to provide additional details that can help your doctor understand you better?
No
Yes
Please share them here...
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Payment for Online Consultation
Information
First Name
*
Last Name
*
Phone Number
*
House No
*
City
*
Postal Code
*
Payment Information
DATE
3/14/2025
ORDER NUMBER
1721758328
STORE NAME
Medgic.pk
AMOUNT FOR CONSULATION
Rs/- 1500.00 Only
SUMMARY
Online Consultation Fee
Proceed to checkout Rs/- 1500
