If you do not know your blood pressure you can have this measured at your local pharmacy/GP surgery.

<ul>
<li>Any heart problems including angina, chest pain, heart failure, irregular heart beats, heart attack (myocardial infarction), left-ventricular outflow obstruction, cardiomyopathy or valvular heart disease (e.g.aortic stenosis).</li>
<li>Stroke</li>
<li>Sight loss due to poor circulation</li>
<li>Sight loss because of non-arteritic anterior ischemic optic neuropathy (NAION)</li>
<li>Blood problems such as haemophilia, sickle cell anaemia (an abnormality of red blood cells), leukaemia (cancer of blood cells)</li>
<li>Stomach ulcers (e.g. peptic/gastric ulcer)</li>
<li>Liver problems</li>
<li>Kidney problems</li>
<li>An erection that lasted more than 4 hours</li>
<li>Any physical condition affecting the shape of the penis (e.g. angulation, Peyronie’s disease and cavernosal fibrosis)</li>
<li>Inherited eye disease - retinitis pigmentosa</li>
<li>Multiple myeloma (cancer of the bone marrow)</li>
<li>Galactose intolerance, Lapp Lactase deficiency or glucose-galactose malabsorption</li>
<li>Any serious medical condition which may require immediate hospitalisation</li>
</ul>

<ul>
<li>Often taken for chest pain/angina</li>
<li>Can be administered as a spray, tablet or patch.</li>
<li>Include glyceryl trinitrate, isosorbide mononitrate or isosorbide dinitrate</li>
</ul>

Do you understand that erectile dysfunction can be associated with a number of contributing conditions eg hypertension, diabetes mellitus, high cholesterol or cardiovascular disease and you should consult your doctor within 6 months of starting treatment for a clinical review?

In the rare event, I obtain a prolonged erection of more than 4 hours or experience any sudden visual impairment, I agree that I will seek immediate medical assistance.

<ul>
<li>This medication is for my personal use only.</li>
<li>I understand and have answered the questions above honestly.</li>
<li>I understand the side effects and effectiveness of these treatment options. This includes any alternative options available.</li>
</ul>

Are you male and aged between 18-75?