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Please answer all questions honestly and completely so our health professional can ensure suitability and prevent any delays in supplying your medication
Has not been advised by their doctor to avoid sexual activity
Does not have any disease of deformity of the penis (such as Peyronie’s disease)
Does not have a penis which looks red or sore, or appears damaged or broken.
YesNo
Test
Test
Eroxon
Eroxon
Changes to your medical status
By repeating the order, you are confirming the requested medication is working as intended, and you are not suffering from any undue side effects. If this is not the case, please do not repeat this order.
If you wish to repeat this order, please confirm that since your last order
There has to been any changes to your health
You have not started any new medication
You are not under investigation for any health conditions that have not yet been diagnosed.
If there has been any changes since your last order please do not repeat this order and fill out a new medical consultation.
