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Ask Our Herbalist
To enable us to advise you of what we consider to be the best course of action and assess your sexual health in more detail. You may prefer a confidential on line evaluation with a herbal specialist. If so then please take the time to answer the following questions:

(Please Note all information we hold is strictly confidential:)

name (*)

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Email (*)

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Age (*)

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Occupation

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Where did you about us?

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Part One: Your Social Environment

What build do you consider yourself to be?

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How is your blood pressure?

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Do you or did you smoke - if so how many a day?

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Do you drink alcohol regularly and if so how much? 1 small glass of wine = 1 unit

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Per week or per day?

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Do you take any recreational drugs?

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Do you take regular aerobic exercise?

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Have you ever suffered from any cardiovascular problems (heart/circulation problems) or had a stroke?

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Do you suffer from any allergies?

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If yes please be specific and provide the name of the medication, and the reason why you are taking it.

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Do you feel as if you know why you have erection difficulties? If so please give details:

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Part Two: Relationaships and Mental Health

Do you have difficulties in achieving erections sufficient for penetration?

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Do you generally have difficulties in maintaining an erection during sex?

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How long have you been suffering from this problem?

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Do you suffer from premature ejaculation?

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Do you suffer from anxiety prior to or during sex?

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Do you suffer from lack of desire?

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Do you find your partner sexually attractive?

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Is your personal relationship harmonious?

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How often do you have sex?

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times per...



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Do you have difficulty achieving and maintaining an erection?

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Do you get erections during sleep or on waking?

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Part Three: Your Physical Health

Do you have or have you ever had a medical condition where sexual intercourse is not advised? e.g. Any severe heart disorders, unstable angina.

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Are you take HIV Medication – protease inhibitor ritonavir?

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Are you taking Saquinavir, Erythromycin, Ketaconazole or Itraconazole?

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Are you taking any Nitrate Oxide Donors (such as Amyl Nitrate) or Nitrates in any form?

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Are you taking any other herbal medicine?

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In your and your doctors opinion would you consider yourself to be in...

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I am over 18 and have read and understood and agreed to the terms and conditions

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You can make an appointment for any disorders or concerns you have, or a condition you wish to improve.





 
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