Online Pharmacy Delivery Canada | TreatMeNow

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Since these are prescription meds, we need to ask a few health questions.

Why we ask: Your answers help the licensed clinician determine if treatment is right for you.

Here's how it works:

Answer a few quick questions
Choose your treatment
Complete your order and checkout

You're charged only if the medication is shipped. If your doctor determines the treatment isn't right for you, your order will be canceled automatically and you'll receive a full refund—simple, secure, and stress-free.

Your privacy matters. All provided information is securely encrypted and accessible only by a licensed Canadian clinician and pharmacist, ensuring strict compliance with privacy and confidentiality regulations.

Erectile Dysfunction Questionnaire

When did your symptoms start?

In the last month

In the last 6 months

6 months ago or longer

Not sure

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Erectile Dysfunction Questionnaire

What symptoms have you experienced in the last 12 months?

Difficulty getting an erection

Difficulty maintaining an erection during sexual activity

Not experiencing erections in the morning.

Pain with erections or ejaculation.

Foreskin that is too tight.

Premature ejaculation / ejaculate too quickly.

I do not have any issues with my erections

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

When do you experience these symptoms?

When I engage in sexual activity with others

When I masturbate

When I'm stressed or anxious

When I drink alcohol

When I'm with a new sexual partner

Other

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Erectile Dysfunction Questionnaire

Do you get erections at night and/or when you wake up in the morning?

Always

Sometimes

Never

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Erectile Dysfunction Questionnaire

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

What heart or cardiovascular conditions have you had?

Abnormal heart rate or arrhythmia

Long QT syndrome

Heart attack

Angina or chest pain

Heart valve disease

Hypertension

Cardiomyopathy

Using nitroglycerin, isosorbide, or any other nitrate medication

Other

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Erectile Dysfunction Questionnaire

Have you had a heart attack in the last 3 months?

Yes

No

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Erectile Dysfunction Questionnaire

What diseases of the genitals or urinary symptoms have you had?

Prostate disease

Pelvic surgery

Prostate or pelvic radiation

Penis or genital scarring or injury

Peyronie's disease

Other

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Erectile Dysfunction Questionnaire

Are you currently using ED medication?

Yes

No

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Erectile Dysfunction Questionnaire

Have you ever taken medication or supplements for ED before?

Yes

No

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Erectile Dysfunction Questionnaire

How can we help today?

I want to get a new prescription

I want to change my medication

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

What’s the name of the medication you were taking?

Please provide any details related to the treatment, dosage and effectiveness.

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Erectile Dysfunction Questionnaire

Have you had a physical exam with a healthcare provider in the past 5 years?

Yes, everything was normal.

Yes, they found issues

No, I have not.

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

Have you had blood work done in the last 2 years for ED?

Yes, everything was normal.

Yes, they found issues.

No, I have not.

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

What was your most recent blood pressure reading?

Low-Normal (120/80 or lower)

Above Normal (between 121/80 to 129/80)

High (between 130/81 to 139/89)

Higher (greater than 160/90)

I don't know my blood pressure, I will get a new reading

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

Do you experience any of the following cardiovascular symptoms?

Chest pain or shortness of breath when climbing 2 flights of stairs or walking 4 blocks

Chest pain or shortness of breath with sexual activity

Unexplained fainting or dizziness

Prolonged cramping of the legs with exercise

Abnormal heart beats or rhythms

None of these apply to me

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

Please tell us more about your prolonged leg cramps.

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Erectile Dysfunction Questionnaire

Tell us about your lifestyle.

Understanding your lifestyle helps us provide you with the highest possible level of care.

I smoke tobacco, vape nicotine, and/or use other tobacco products

I drink more than 10 alcoholic drinks per week

I use recreational drugs

I get less than 2 hours exercise per week

I do not eat as healthy as I would like

I get less than 7 hours of sleep per night

I am frequently under a lot of stress

None of these apply

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

What recreational drugs do you use?

Poppers or Rush

Amyl Nitrate or Butyl Nitrate

Cocaine

Other

No, I don't use any of these

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

Do you have kidney or liver problems?

I have kidney problems

I have liver problems.

I have no liver or kidney issues.

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

Please list any surgeries or hospitalizations. If none, please continue.

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

Do you have any other information or questions for the doctor?

Yes

No

Call us at 1-877-853-0312

Erectile Dysfunction Questionnaire

PDE5i Consent

You have been diagnosed with or have reported that you have a known diagnosis of organic or psychogenic (situation) erectile dysfunction, a condition characterized by the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. Phosphodiesterase Type 5 Inhibitors (PDE5i) are medications prescribed to treat this condition by enhancing erectile function.

Common PDE5 inhibitors include Sildenafil (Viagra), Tadalafil (Cialis), Vardenafil (Levitra), and Avanafil (Stendra). These medications work by increasing blood flow to the penis during sexual stimulation.

The use of PDE5 inhibitors may improve your ability to achieve and maintain an erection, enhance sexual performance and satisfaction, and improve your quality of life and personal relationships.

While PDE5 inhibitors are generally well-tolerated, possible side effects may include headache, flushing, indigestion or upset stomach, nasal congestion, dizziness or lightheadedness, visual disturbances such as blurred vision or changes in color perception, back pain or muscle aches (more common with Tadalafil), hearing loss or ringing in the ears (rare), priapism (a prolonged erection lasting more than four hours), and allergic reactions like rash, itching, or swelling. Do not use PDE5 inhibitors if you take nitrates for chest pain (angina), use recreational drugs called "poppers" (amyl nitrate or nitrite), have severe heart or liver problems, have recently had a stroke or heart attack, or have low blood pressure.

Alternative treatments include lifestyle changes such as exercise, weight loss, quitting smoking, and reducing alcohol intake; psychotherapy or counseling for psychological causes of erectile dysfunction; vacuum erection devices, which are mechanical pumps to induce erections; penile injections or suppositories where medications are administered directly to the penis; hormone therapy if low testosterone levels are contributing to erectile dysfunction; and surgical options like penile implants or vascular surgery.

I consent to the use of PDEi5 inhibitors for the treatment of my erectile dysfunction.

Yes, I consent.

I have read the above information and I do not wish to continue

Call us at 1-877-853-0312

Acknowledgement

Pharmacy Consent

I understand my prescription medication will be shipped to my door from a participating mail order pharmacy.

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