Do you take any of the following medications?*

Nitroglycerin spray, ointment, patches or tablets (Nitro-Dur, Nitrolingual, Nitrostat, Nitromist, Nitro-Bid, Transderm-Nitro, Nitro-Time, Deponit, Minitran, Nitrek, Nitrodisc, Nitrogard, Nitroglycn, Nitrol ointment, Nitrong, Nitro-Par)

Isosorbide mononitrate, or isosorbide dinitrate (Isordil, Dilatrate, Sorbitrate, Imdur, Ismo, Monoket)

Other medicines containing nitrates

Nitric Oxide supplements/boosters

Non-uroselective alpha blockers, doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin)

Uroselective alpha blockers ((i.e. Flomax (tamsulosin), Uroxatral (alfuzosin), and Rapaflo (silodosin))

Riociguat (Adempas)

None apply

Do you experience any of the following cardiovascular symptoms?*

Chest pain when climbing 2 flights of stairs or walking 4 blocks

Chest pain with sexual activity

Unexplained fainting or dizziness

Pain, ache, discomfort or fatigue in the calves, thighs, buttocks, hips or feet with exercise that improves immediately with rest

Abnormal heart beats or rhythms

None of these apply to me

Which of the following prostate conditions do you have?*

Prostate cancer

Enlarged prostate (BPH)

None apply to me

Thank you for your information, based on some of your responses we highly recommend speaking with your physician before using our products and services.

Thank you for your information, based on some of your responses we would like to get more detailed on how we can best provide our product to you.

Thank you for your information, based on some of your responses we highly recommend speaking with your physician before using our products and services.

Thank you for your information, based on some of your responses we would like to get more detailed on how we can best provide our product to you.

info@everreadyproducts.com

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