ED Quiz – Hard Candy

Step 1 of 8

Let's make sure you're eligible for treatment

It's just like intake forms at the doctor.

Patients must be male (sex assigned at birth) and at least 18 years of age.

Sex assigned at birth(Required)

Male

Female

Date of Birth(Required)

MM slash DD slash YYYY

State(Required)

Email(Required)

Phone(Required)

SMS Consent(Required)

I agree to receive text messages from Hard Candy with important updates, including prescription reminders, order updates, exclusive offers and information about new products. Message and data rates may apply. Message frequency varies.(Required)

How often are your erections firm enough for sex?(Required)

Rarely

A few times

Sometimes

Most times

Almost always

How often can you stay hard once sex begins?(Required)

Rarely

A few times

Sometimes

Most times

Almost always

How difficult is it to stay hard until finishing?(Required)

Extremely difficult

Very difficult

Somewhat difficult

Slightly difficult

Not difficult

Any heart or blood pressure issues?(Required)

Select all that apply.

Heart attack or stroke in last 6 months

Severe heart disease or unstable angina

Uncontrolled high blood pressure

Very low blood pressure (<90/60)

Arrhythmias

None

Based on your response, you are ineligible to complete your assessment.

Please see your physician or call us if you have any questions. Customer Care: +1 (310) 975-5351

Any vision or neurological conditions?(Required)

Select all that apply.

Vision loss from NAION

Retinitis pigmentosa

Parkinson’s disease

None

Based on your response, you are ineligible to complete your assessment.

Please see your physician or call us if you have any questions. Customer Care: +1 (310) 975-5351

Are you taking any of these medications, drugs, or have any of these conditions?(Required)

Select all that apply.

Nitrates (nitro, isosorbide, poppers)

Riociguat / Verquvo

Alpha-blockers (tamsulosin, doxazosin)

MAO inhibitors

Strong CYP3A4 inhibitors (ritonavir, ketoconazole)

Cocaine / meth / MDMA

Poppers (amyl nitrate)

Severe Peyronie’s disease

Told not to have sex

Allergy to sildenafil

Allergy to tadalafil

Allergy to apomorphine

None

Based on your response, you are ineligible to complete your assessment.

Please see your physician or call us if you have any questions. Customer Care: +1 (310) 975-5351

Name(Required)

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Set your password(Required)

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Set the password you will use to log in to your account