Beconase Hayfever Relief for Adults 0.05% Nasal - 100 Spray (N)

Are you male and aged between 18-75?
Yes No We are unable to supply you with medication for erectile dysfunction. Please consult your GP.

Do you smoke or drink?
Yes No You are eligible for treatment, however, be aware alcohol and/or smoking can make erection difficulties worse. Consult your GP for information on quitting smoking.

Have you taken Viagra (sildenafil), Levitra (vardenafil), Nipatra, Spedra, or Cialis (tadalafil) at least 4 times previously without any side effects?
Yes No As you have not previously taken any erectile dysfunction medication, we will not be able to supply you with a high-strength treatment as you must try a standard-strength first.

Do you have trouble achieving or maintaining your erection?
Yes No It does not appear that you have erectile dysfunction. We are unable to supply you with treatment. Please consult your doctor for more information.

In the past 6 months, how often do you have difficulty getting and/or sustaining an erection during sexual activity?
Always
Often
Occasionally

Do you have high blood pressure (above 160/90) or are you currently on treatment for high blood pressure?
Yes No We are unable to supply you with treatment if you have high blood pressure. Please consult your GP for more information.

Do you have low blood pressure (below 90/50)?
Yes No We are unable to supply you with treatment if you have low blood pressure. Please consult your GP for more information.

Have you been advised to avoid strenuous exercise?
Yes No We are unable to supply you with treatment. Please consult your GP for more information.

Are you taking any medicines known as nitrates (often taken for chest pain/angina) or nitric oxide donors (‘poppers’)?
Yes No We do not advise any recreational drug use with PDE5 inhibitors, but especially nitric oxide donors such as ‘poppers,’ which may lead to a dangerous fall in your blood pressure. We are unable to supply you with treatment. Please consult your doctor for more information.

Are you currently taking any medication (including over-the-counter, prescription, or recreational drugs)?
Yes No

Do you understand that erectile dysfunction can be associated with conditions like hypertension, diabetes, high cholesterol, or cardiovascular disease and that you should consult your doctor within 6 months of starting treatment for a clinical review?
Yes No You must agree to this before continuing. If you need assistance, contact customer support.

In the rare event that you obtain a prolonged erection of more than 4 hours or experience sudden visual impairment, do you agree to seek immediate medical assistance?
Yes No You must agree to this before continuing. If you need assistance, contact customer support.

Do you agree to the following?

• You will read the patient information leaflet supplied with your medication.
• You will inform your GP if you experience side effects or start new medication.
• The treatment is solely for your own use.
• You have answered all questions truthfully.
• You understand that incorrect information can be hazardous to your health.

I agree to the Terms and Conditions and confirm that I am over 18. You must agree to continue.