How did you hear about Peak Prime Health? *Friend ReferralGoogleSocial MediaAdsAre you confident about getting an erection? *The IIEF-5 survey is an international standards for assessing ED severityAre you confident about getting an erection?1 Never or almost never2345 Always or almost alwaysIs your erection hard enough for penetration? *The IIEF-5 survey is an international standards for assessing ED severityIs your erection hard enough for penetration?1 Never or almost never2345 Always or almost alwaysAre you able to maintain your erection till completion? *The IIEF-5 survey is an international standards for assessing ED severityAre you able to maintain your erection till completion?1 Never or almost never2345 Always or almost alwaysAre you satisfied with sexual intercourse? *The IIEF-5 survey is an international standards for assessing ED severityAre you satisfied with sexual intercourse?1 Never or almost never2345 Always or almost alwaysDo you take any medications containing NITRITES? *eg. glyceryl trinitrate (GTN), isosorbide dinitrate and isosorbide mononitrate.Do you take any medications containing NITRITES?1 Never or almost never2345 Always or almost alwaysDo you have any known heart diseases or previous strokes? *Eg. Heart attack, cardiomyopathy, arrhythmia or heart irregularities.Do you have any known heart diseases or previous strokes?YesNoDo you have any difficulties climbing at least TWO flights of steps? *You may have heart issues if you have difficulty climbing stairs.Do you have any difficulties climbing at least TWO flights of steps?YesNoDo you have any known drug allergies? *Do you have any known drug allergies?YesNokindly state what medication you are allergic. Please describe. *Username *Email *Password *Submit
