ED Online Consultation - RXCompoundStore.Com

Electronic Medical Consultation

Patient consent to download medical history *

Online Treatment Agreement *

I understand that an online medical visit can be a great option for minor medical issues and not ideal for severe or life-threatening illnesses. I understand that treatment offered on CallonDoc.com is on the basis of clinical judgment, in the absence of a complete physical examination. I agree to follow up with a doctor for in-person evaluation or seek emergency care if my symptoms worsen or do not improve in a timely manner.

Do you have any condition that may render you incompetent of making sound medical decisions? *

Do you have an allergy to a particular medication? *

If any, list all the medicines you are allergic to

Do you have any of these conditions? *

Do you have hypertension *

Do you take any of these medications? *

List all the medications you take, including over-the-counter drugs. (Enter None if nonapplicable) *

ED EVALUATION - Briefly describe your ED symptoms and reason for this consultation *

Which of these medical conditions apply to you? * *

Low libido (lack of interest in sex)
Premature ejaculation
Erectile dysfunction
I drink alcohol excessively
I have problems within my relationship
I suffer from depression, anxiety, bipolar, psychosis or other psychiatric disorders

When did your symptoms start? *

What medications have you taken or currently taking for ED? Write N/A if none *

If applicable, briefly explain your last visit to the doctor for ED

Prescription will be sent to RxCompoundStore, 8950 SW 74th Court, Suite 101, Miami, FL 33156. Ph: 786-803-8947. *

Treatment Warning and Precaution *

I understand that I must not take Viagra or Cialis with Nitrates, terazosin, doxazosin, tamsulosin, alfuzosin, and silodosin or fluconazole to avoid severe adverse reaction