Your 2 minute consultation

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You'll need

Before you get started, it's a good idea to make sure you have the following information to hand:

  • Weight and height
  • Photo of your face
  • Blood pressure reading
  • Photo of your ID

About you

Our doctors need to learn a little bit about you to help understand your condition.

What's your biological sex?

  • Male
  • Female

Cellphone number (mandatory)

e.g.5556661234. Please do not add +1. Enter only 10 digits, no spaces. * By entering your number, you agree to receive mobile messages related to your order.

What state do you live in?

What's your date of birth?

What do you weigh?

How tall are you?

Your health

We need to see if your medical history could affect the treatment options.

Do you smoke?

On average, how many units of alcohol do you drink in a week?

If you're not sure, you can calculate the number of units using our guide here: How many units of alcohol do I drink?

Do you drive or operate heavy machinery?

Do you have any known allergies to any medications or substances?

Do you suffer from any problems with your liver or kidneys, your urinary system or digestive system?

Are you currently taking any other prescription-only medications, alternative medications or recreational drugs than already mentioned?

Do you suffer from any of the following:

Chronic heart condition including angina

Heart rhythm irregularities

Problems with your heart valves / prior heart attack / heart failure / narrowing of the arteries

Narrowing of the arteries in your neck

Migraines or severe headaches

High or low blood pressure

Epilepsy or seizures

Fainting or collapsing

Dizziness when you stand up or after lying down

HIV or severe insufficiency of the autonomic nervous system

Bleeding or clotting disorder

Any mental health conditions e.g. depression, anxiety etc.

Sickle cell anemia, myeloma, or leukemia

Retinitis pigmentosa or anterior ischemic optic neuropath

Idiopathic hypertrophic subaortic stenosis

Any history of QT prolongation in you, or even your family

Multiple sclerosis (MS) or similar disease, spinal injuries or paralysis, or neurological diseases****

Stomach, intestinal, or bowel ulcers


None of the above

Have you ever had prostate surgery or been diagnosed with any conditions of the prostate?

Do you suffer from any conditions where sexual activity is not advised?

Do you have any other health problems or conditions that you think we should know about?

Premature Ejaculation

These questions let our doctor know how Premature Ejaculation affects you

Do you have any problem getting or maintaining an erection that is sufficient for penetration?

Do you have any pain in your genitals, when you ejaculate or when you pass urine?

How long have you had problems with premature ejaculation?

How long have you been sexually active?

How difficult is it for you to delay ejaculation?

Have you ever had any treatment for your premature ejaculation? (This includes prescription or over the counter medications, behavioural modifications, supplements etc.)

Do you experience any of the following conditions:

Ejaculation before you want to

Ejaculation with little stimulation

Frustration or distress due to premature ejaculation

None of the above

How concerned are you that your time to ejaculation leaves your partner unfulfilled?

Do you feel that your premature ejaculation is causing a problem in your relationship?

How soon after penetrating your partner do you ejaculate?

Do you have any of the following conditions:

Peyronie's disease or a curve or bend in the penis that interferes with sex

Painful erections or ejaculations

A foreskin that is too tight

Fibrous tissue in the penis (lumps and bumps under the skin that feel hard)

None of the above

If you have any of these penis conditions listed above, please provide further details of any pain you experience, if this condition interferes with your sex life and if you are recieving or have recieved any treatment for this condition?

If you do not have any of the conditions listed above, please write NA in the box above.

Do any of the following factors apply to you:

I do not get as much exercise as I should

I do not eat as healthily as I should

I smoke tobacco or vape

I drink more than I should (more than 2 drinks/day)

I do not sleep as much as I should

I'm frequently under stress

I'm 20+ lbs overweight

None apply

Premature ejaculation can be caused by certain lifestyle factors - correcting these, can sometimes improve PE symptoms.

Do you know what could be the cause of your premature ejaculation?

Have you previously tried any premature ejaculation treatments?

In the last 3 years, have you have a medical examination of your genitals (penis, testes, and groin)?

Is there any other information you would like to share with us, to help our doctors make an informed and a fair decision?

Your consent

We need to make sure that you are aware of and agree to some criteria before you choose your medicine.

I agree to the terms and conditions

  • I confirm I am 18 years old or above
  • I am using this service on my own behalf and of my own free will and any treatment or advice is for my sole use only
  • I understand my consultation will not be passed to the Medzino clinical team until I have successfully completed payment
  • I will read the patient information leaflet supplied with the medicine or obtain it from the Mezino website; especially the side effects and dosages.
  • I take responsibility to inform my own regular doctor of the online consultation or any changes in my circumstances.
  • I agree to the Medzino terms and conditions.
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