Please register first to obtain treatment
Registration is free and without obligation to order

Registration Explained

To continue your order, please complete the registration form, this will take about 2 minutes. The information is for the sole use of the Doctor to assess your condition and approve you for treatment if applicable. The information will not be used for any other marketing purposes whatsoever.

For further information, please check our registration FAQ's.

Registered with the care Quality Commission

Questions Related to Premature ejaculation

In order to prescribe treatments for Premature ejaculation our doctor needs some information regarding this specific condition. Please complete the following as accurately as possible.

I confirm that I suffer from PE and cannot control when I ejaculate.

Yes No

How long have you been sexually active?

How long have you been suffering from premature ejaculation?

Less than 1 year more than 1 year

How often do you experience PE?

Do you ejaculate quickly when masturbating?

Yes No

Can you manage to penetrate and or maintain an erection beyond two minutes without ejaculating?

Yes No

Does your PE affect the relationship you are in?

Yes No

Does that cause you distress?

Yes No

What treatments, if any, have you tried for PE in the past?

Do you suffer from any prostate problems such as infection or enlargement?

Yes No

Are you taking any antidepressants?

Yes No

Do you suffer from panic attacks and/or do you ever experience suicidal throughts?

Yes No

Do you suffer from bipolar disease, mania or seizures?

Yes No

Do you suffer from kidney (renal) or liver (hepatic) disease?

Yes No

Do you have any heart problems, particularly affecting the heart rhythm or palpitations?

Yes No

Do you faint easily or do you feel dizzy when standing up too quickly after lying down?

Yes No

I understand Priligy and ED medicines (Viagra, Cialis and Levitra) must not be taken at the same time as this could cause low blood pressure and fainting. To avoid these side effects I understand I must leave at least 2 weeks between taking Priligy and taking Viagra, Levitra or Cialis.

Have you been diagnosed with low blood pressure or postural hypotension?

Yes No

Do you drive Heavy Goods Vehicles or use heavy machinery?

Yes No

© 2004 - 2018 FMC Marketing Limited, UK CQC-registered company working with medical professionals GMC registered doctors and UK-registered pharmacies.
Our Doctors:
Doctor Nitin Shori (Clinical Lead) - GMC Reference Number: 6047293
Doctor Alexandra Phelan - GMC Reference Number 6150198

FMC Marketing Limited is registered in England No. 04780577 Registered address; Hampshire House, 204 Holly Road, Aldershot, Hampshire, GU12 4SE