Confirmation Required
If you proceed with an order, our doctor will call you on the below number to explain potential side effects and answer any questions you may have. Please ensure that your phone number is correct as the doctor cannot write a prescription without speaking with you first.
Answer seven quick questions about your general health to get the most effective clinically proven treatments for you.
DO YOU AGREE AND CONSENT TO THE FOLLOWING?- I am male, over 18 years old and live in Australia.
- I shall be the sole user of any medication offered to me through this service.
- I confirm all answers are provided by me, and will be truthful.
- I agree to the terms and conditions.
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1
Would you like to skip the questionnaire and speak with a Doctor instead?
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2
Do you take any regular medications, have any known allergies or any medical issues?
3
Please list any regular medications you take, any known allergies or any medical issues.
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1
You must be over 18 years old to use this service. Please enter your date of birth *
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Please use this format (DD/MM/YYYY)
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2
Do you have difficulty getting or maintaining an erection? *
3
Do you have, or have you ever had, any heart or neurological conditions? *
4
Do you have any of the following problems?
- Heart attack, stroke or mini stroke within the last 6 months
- Chest pain symptoms or any heart rhythm issues
- Heart valve problems
- Disease of the heart muscles
- Get breathless or have chest pain with light exertion, such as walking briskly for 20 minutes or climbing two flights of stairs
5
Please tell us more about what heart or neurological condition you do have.
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6
Do any of the listed medical conditions apply to you?
- Significant liver problems (such as cirrhosis of the liver) or kidney problems
- Currently prescribed GTN, Isosorbide mononitrate, Isosorbide dinitrate , Nicorandil (nitrates) or Rectogesic ointment
- Abnormal blood pressure (lower than 90/50 mmHg or higher than 160/90 mmHg)
- Condition affecting your penis (such as Peyronie's Disease, previous injuries or an inability to retract your foreskin)
- History of loss of vision in one eye because of damage to the optic nerve (non-arteritic ischaemic optic neuropathy) or a hereditary retinal problem such as retinitis pigmentosa
- Galactose intolerance, Glucose-galactose malabsorption or Lapp lactase deficiency (this is different to Lactose intolerance)
- Any bleeding conditions (e.g. haemophilia)
- Stomach/duodenal ulcer in the last 3 months
- Advised to avoid sexual activity for any medical reason. *
7
Are you taking any of the following drugs?
- Alpha-blocker medication such as Alfuzosin, Doxazosin, Tamsulosin, Prazosin, Terazosin or over-the-counter Flomax
- Riociguat or other guanylate cyclase stimulators (for lung problems)
- Saquinavir, Ritonavir or Indinavir (for HIV)
- Cimetidine (for heartburn)
- Ketoconazole or Itraconazole (for fungal infections)
- Erythromycin or Clarithromycin (antibiotics)
- Diltiazem (for high blood pressure)
- Recreational drugs known as “Poppers” or “Cocaine”. *
8
Are you taking any medications (including over the counter or herbal medicines)? Do you have any other medical condition or previous operations not already mentioned? *
9
Please list all your medications you take and any other medical conditions or previous operations.
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15
Would you prefer to take it as needed or daily? *
11
What dose have you taken before? For example: 25mg, 50mg or 100mg
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12
Discretion is at the heart of what we do but for legal reasons the name on your prescription must be your full legal name. Please provide your legal name as per your official government ID. *
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13
Based on your medical history and individual needs, our doctors have provided personalised treatment. Please complete your mobile phone number to view recommended treatment. *
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15
Do you have a Medicare card?
15
Please enter your Medicare Card details
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15
What is your IHI?
Your IHI is located next to your Covid vaccine certificate. If you are an international student or working visa holder, for our doctors to write a prescription, you first need to register for myGov and an IHI (Individual Health Identifier). You can do this all online within minutes. Please take a look at the Services Australia website for complete instructions, click here.
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4
Do you have a medication preference?
5
Enter the name of medication below
6
Please select your preferred strength
7
Have you taken 100mg before?
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6
How many uses?
7
Do you prefer to take daily?
Unfortunately you are not eligible for 100mg as you have never taken it before. Please select a different strength.
If you made a mistake, you can go back and correct your answer.
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Unfortunately based on your answer you would not be suitable for treatment. If you would like to speak with the Burst doctor to discuss other treatment options, please book an appointment here.
If you made a mistake, you can go back and correct your answer.
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Please follow this link to book a $85 consultation with our doctor:
Click here to book If you made a mistake, you can go back and correct your answer.
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That date isn't valid. Check the month and day aren't reversed.
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