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FlexiCare
Our ED Treatment program is intended for adult men experiencing weak erection (erectile dysfunction)—the difficulty in getting or keeping an erection firm enough for satisfying sexual activity. Please confirm the following:
I am 21 years old or older.
I am male.
I confirm that all of the above statements are true and accurate.
Have you ever had any heart condition—past or present?
Yes
No
Do you ever feel something might be wrong with your heart—even if it hasn’t been officially diagnosed?
Yes
No
Do you experience chest pain or feel very breathless during light or moderate activity—like brisk walking for 20 minutes or climbing two flights of stairs?
Yes
No
Are You Currently Taking Any Medications? This includes prescription drugs, over-the-counter medicines, recreational substances, or anything you take occasionally.
Yes
No
Do you have or have you ever had any of the following? Please check any of the conditions you’ve had or currently have:
Doctor's advice to avoid sexual activity
An erection that lasted more than 4 hours
Severe liver or kidney problems
Vision loss related to blood flow
Bleeding disorders
Sickle cell anaemia or leukaemia
Physical deformity of the penis (e.g. Peyronie’s disease)
Any other serious health condition you'd like us to know about
I don’t have any of these conditions
First Name
Last Name
Phone Number
Email address
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