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 and aged between 18-64 years?

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

Have you been prescribed this before?

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

Have you experienced premature ejaculation on several occasions in the last 6 months?

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

Does premature ejaculation cause you any distress or does it cause problems in your sexual relationships?

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

Do you ejaculate within 2 minutes of vaginal penetration?

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

Do you intend to take this medication with alcohol in your system?

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? 

  • Mental health problem such as depression, mania , bipolar disorder or schizophrenia.
  • Epilepsy
  • Heart problems (e.g., angina, chest pain, heart failure, irregular heartbeat, heart attack or narrowing of the aortic valve)
  • A history of bleeding or blood clotting problems
  • Kidney or Liver problems
  • Low blood pressure (<90/60)
  • Any serious medical condition which may require immediate hospitalisation

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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