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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))
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?
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.
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