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Weak Erections, Impotence or Erectile dysfunction
Sexual health is an important part of an individual's overall physical and emotional well-being. Erectile dysfunction is one type of very common sexual complaint. There are many different treatment options for erectile dysfunction. This questionnaire is designed to help you and your physician identify the nature and severity of your erectile dysfunction and to discuss potential treatment options.
Each question has several responses from which you are asked to choose the one that best describes your own situation. Please be sure that you select only one response per question.
Please ensure all information is completed correctly in order for us to respond to your assessment promptly.
PLEASE NOTE: If you want your order to be delivered to your preferred location. There will be a courier fee charged separately from the online store order. Dismiss