Select 'Yes' if you give permission to share this information with or seek more information from your GP, we will hold your order until GP approval has been given. Not providing consent may limit the services provided by the prescriber.

Have you seen your GP about your condition?

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Are you male?

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Do you have difficulty getting or maintaining an erection (erectile dysfunction)?

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Have you had this problem for more than 12 months?

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Have you been advised by a doctor to avoid strenuous exercise?

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Would you find it challenging to walk at a fast pace for 5 minutes?

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Have you been diagnosed with any of the following? 

  • Heart disease including history of heart attack or angina (chest pain when exercising)
  • Low or High BP
  • Previous stroke or mini-stroke (transient ischaemic attack)
  • History of loss of sight due to poor circulation
  • The inherited eye disease retinitis pigmentosa (rare)
  • Kidney or liver disease
  • Any deformity of the penis (e.g. Peyronie's Disease)
  • Sickle cell disease or leukaemia or multiple myeloma
  • Tendency to bleed excessively (e.g. haemophilia)
  • Stomach ulcers (also known as peptic/gastric ulcer)
  • Loss of vision due to non-arteritic anterior ischaemic optic neuropathy (NAION)
  • Galactose intolerance, Lapp Lactase deficiency or glucose-galactose malabsorption

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Are you taking any of the following medications? 

  • Medicinal nitrates or recreational nitrates such as amyl nitrate also known as “poppers”
  • Alpha blockers (used to treat high blood pressure or urinary symptoms associated with benign prostatic hyperplasia
  • Medicines to treat high blood pressure 
  • Antivirals
  • Medicines known as protease inhibitors, such as for the treatment of HIV, or anti-virals including (Atazanavir, etravirine, fosamprenavir, indinavir, nelfinavir, ritonavir, saquinavir)
  • Nicorandil
  • Anti-fungal medication such as Ketoconazole or itraconazole
  • Quinidine/Procainamide/Amiodarone
  • Theophylline
  • Macrolide antibiotics such as Erythromycin/clarithromycin
  • Phenobarbital, phenytoin and carbamazepine
  • Salbutamol

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

Standard T&C

  • I will read the patient information leaflet supplied with my medication
  • I will contact my GP or MyMedsUK if I experience any side effects
  • The treatment is for my use only
  • I have answered the assessment questions truthfully and accurately
  • I agree to the Terms and Conditions and I confirm that I am over 18 years old
  • I am aware that I may be contacted to give further information via phone or email and if I am not contactable this will lead to a delay in receipt of my prescription

Sorry we cannot supply you with this treatment on this occasion. Please see your GP for further advice.

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