Consultation Questionnaire

Please complete all questions

As pointless as some questions may seem, you are required to complete the questions and just insert N/A if they do not apply to you.

Have you experienced any of the following in the past or are currently experiencing:

Do you have or ever had difficulty experiencing orgasms?

Urinary Symptoms?

Do you have difficulty obtaining an erection?

Painful ejaculation?

1 + 5 =