Item Selected: Cialis Together 10mg Tablets
This questionnaire is essential for your consultation today. Please be truthful and include any current medications, medical history, and other relevant information. This helps our prescribers offer the best advice and medication for your needs. Read all medical information before selecting your treatment.
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What is your date of birth?
Do you have, or have you ever had a heart problem (including any problems with your heart, blood pressure, feeling dizzy, blurred vision or a stroke)?
Please provide more information
Do you feel very breathless or get chest pain if you walk fast for 20 minutes or climb 2 flights of stairs?
Have you ever been prescribed any nitrate medicine used to treat or prevent chest pain (angina), heart attack or heart failure?
Are you using any recreational drugs (such as, but not limited to, ‘poppers’ [amyl nitrite] or cannabis)?
Are you taking any other regular medication?
Do you have any health conditions? For example:
Have you ever had loss of vision because of damage to your optic nerve (known as NAION) or do you have an inherited eye disease (e.g. retinitis pigmentosa)?
Do you have Peyronie’s disease or any other condition causing a change in the shape of your penis?
Do you have any allergies or intolerances (e.g. lactose intolerance)?
How many times per week are you sexually active
Have you used this medication before?
Is there anything else you would like to tell the pharmacist about your health or medication?
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