Deprecated
: wp_no_robots is
deprecated
since version 5.7.0! Use wp_robots_no_robots() instead. in
/home/hpadt1bzo9ix/public_html/male-rx.com/wp-includes/functions.php
on line
4861
More
HOME
SERVICES
PRODUCTS
ERECTILE DYSFUNCTION
TESTOSTERONE REPLACEMENT THERAPY
PAIN MANAGEMENT
WEIGHT CONTROL
AGE MANAGEMENT
HAIR RESTORATION
INFO
How Can we Help
Appointment
Chat
Home
Services
Product
Info
How Can we Help
Appointment
Chat
Your cart is currently empty.
Return to shop
Request Appointment For Consultation
"e-Appointment"
×
New Patient?
Yes
No
Name
Email address
Mobile Phone Number
Date of Birth
9:00 am
10:00 am
11:00 am
12:00 pm
1:00 pm
2:00 pm
3:00 pm
4:00 pm
5:00 pm
6:00 pm
7:00 pm
8:00 pm
9:00 pm
Health History
Medications if Any
High or Low Blood Pressure
Y
N
Diabetes Mellitus
Y
N
Kidney Problems(renal failure)
Y
N
Liver Issues
Y
N
Prostate Problems or Surgery
Y
N
Bladder Problems or Surgery
Y
N
Do You Smoke
Y
N
Do You Smoke Marijuana
Y
N
Do You Drink Alcohol
Y
N
Have You Had A Heart Attack Or Do You Have Heart Disease?
Y
N
Has Your Primary Physician Told You Were Healthy Enough For Sex?
Y
N
Do You Have Morning Erections
Y
N
How Long Does Your Typical Erection Last
How HARD Does Your Erection Get
NOT MUCH
SOME
FIRM
Do You Ejaculate Prior To
OR Soon After Penetration
Y
N
Please note: New patient visits are typically 1/2 hours. Our practice will call you to confirm your appointment