&BAM Medical Onboarding

Welcome to Your &BAM Erectile Dysfunction consultation

the easiest way to get hard again 👊🏽
We shy away from medical questionnaires just as much as you, but it's the doctors orders if you want treatment that works. You're looking at about 15 minutes to get this done — beats sitting in the waiting room though!

Give social stigma the middle finger.

ED is really common and affects 40% of men by their forties.

Please provide your contact details

A doctor will contact you once you complete this consult
What is your full name? *

First Name Last Name
What is your sex? *
What is your email? *
No spam, no BS. We need this information for the onboarding process.
What is your mobile number *
No spam, no BS. We need this information for the onboarding process.
What is your date of birth? *

Day Month Year

Next, we're going to dive into your medical history...

Here’s how it works:
1. On the next few screens, you’ll submit information about your health, medical history, erectile dysfunction, and lifestyle.
2. Once you finish, you’ll pay a once-off R150 to complete the doctor’s consult. For &BAM customers, this once-off cost includes all ongoing care, repeat scripting, and doctor check-ups.
3. A doctor will contact you within 24 hours to discuss your submission and personalised &BAM treatment plan.
4. If prescribed, you’ll receive an email to subscribe to your doctor-approved plan so you can get hard and stay hard - on your terms.

Here are the important bits of our Terms of Service summarised.
1. You confirm that you are 18 years of age or older and reside in South Africa.
2. You understand that this platform, video, telephone calls, emails, WhatsApp messaging and SMS will be used by the doctor to render healthcare services to you (telemedicine).
3. You accept and consent to telemedicine for your clinical assessments, prescriptions, refills, appointment scheduling, and education.
4. You provide your consent freely and voluntarily to &BAM and the servicing doctor.
5. You promise to provide honest and accurate information.
6. You agree that the servicing doctor will decide whether or not the condition being diagnosed or treated is appropriate for a telemedicine consultation.
7. You acknowledge that any doctor that engages with you may have an affiliation with &BAM. The doctor will disclose any affiliation at the start of your consultation
8. You can opt-out of receiving care, at any stage, but acknowledge that it may not be in your best interest. If you opt out you release the doctor and &BAM from any obligations and liability arising from your discontinued care.
9. Your data will always be kept HIGHLY confidential and only shared with the required and authorised doctor and &BAM staff. You consent to the processing and transmission of your personal medical information to these parties:
  1. &BAM stores and preserves your data on behalf of both you and the doctor to ensure the doctor is continuously provided with accurate information for continuity of care, in your best interests.
  2. &BAM staff need to know what products and quantities you may need from us so that they can process your order and ship them to you. The types of products could potentially reveal medical conditions/treatment.
  3. Our Privacy Policy lists more details on our data handling practices and security measures (See Privacy Policy - Clause 11).
10. The nature of the tools we use requires that some of your data is transferred across the South African border.
  1. We use a cloud-based e-forms platform in the USA and EU to administer forms and preserve data, including medical history information. USA and EU have legislation on the protection of health data, being HIPAA and GDPR .
  2. Our e-forms platform is HIPAA and GDPR compliant, we have an agreement with them, and they apply the highest security and privacy standards to your data.
11. You may not hold &BAM liable for your use of the platform, services or information. (See Terms of Service: Warranties, disclaimers, indemnities and waivers).
12. Lastly, the Terms of Service lists:
  1. the purpose, cost, and implications of the telemedicine service (See ‘Consent’).
  2. the doctors who may service you as well as their practice number (See ‘Doctors’).
  3. the security measures we have in place to protect your data as well as any material risks that may influence your consent (See ‘Risks’)
13. You will receive a copy of your consent via email. You can withdraw your consent by emailing hello@andbam.care.

General Medical History

This helps our doctor ensure the treatment is safe and suitable for you.
Do you consider yourself to be compliant with medical advice/instruction? *

Yes No
Do you currently take any prescription medicines, over-the-counter medication, herbals, supplements or vitamins? *

Yes No, not taking any medicines, supplements, herbals or vitamins
Please list all prescription medicines, over-the-counter medication, herbals, supplements or vitamins you are currently taking? *
Do you have any allergies or medication reactions? *

Yes, I am allergic to some foods Yes, I am allergic to some medicines No, I have no allergies or medication reactions Other
Please list what foods you are allergic to and the reaction that each allergy causes? *
Please list what medicines you are allergic to and the reaction that each allergy causes? *
Foods, medicines and other
Please list what you are allergic to and the reaction that each allergy causes? *
Foods, medicines and other

In the past 5 years, do any apply to you? *

I have been admitted to hospital I have had an anesthetic I have had a surgery or have a history of prior surgeries Taken any chronic (>2 weeks) prescription (Rx) medication Taken any chronic (>2 weeks) over the counter (OTC) medication None apply to me
Please list and provide details of your hospital admissions in the past 5 years? *
Please list and provide details of your anesthetic in the past 5 years? *
Please list and provide details of your history of surgeries? *
Please list and provide details of your chronic (>2 weeks) prescription medication in the past 5 years? *
Please list and provide details of your chronic (>2 weeks) over the counter (OTC) medication in the past 5 years? *

Have you been diagnosed with? *

Cancer or Malignancy HIV or AIDS No, none apply to me
Please list and provide details of your Cancer or Malignancy *
Please list and provide details of your HIV or AIDS *
Have you been tested for HIV in the past 2 years? *

Yes No, I have not been tested for HIV in the past 2 years

Do you currently suffer from any medical conditions? *

Yes No, I have no current medical condition
Please list and provide details of your medical conditions? *
Do your parents have any chronic medical conditions and/or is there a history of sudden cardiac arrest in your family? *

Yes, my parents have chronic medical conditions Yes, there is a history of sudden cardiac arrest in my family None apply to my parents and family
Please list and provide details of your parents have chronic medical conditions *
Please list and provide details of the history of sudden cardiac arrest in yourfamily *

What is your height in centimeters (cm) and your weight in kilograms (kgs)? *

Rheumatological
Have you experienced any of the following conditions or symptoms? *

Raynaud’s phenomenon or any peripheral vascular disease Rheumatological disorders or autoimmune disease (e.g. lupus, discord lupus, sarcoidosis, psoriatic arthritis No, I have not experienced any of these conditions, events or symptom
Please explain your Raynaud’s phenomenon or any peripheral vascular disease in detail. Have you been, or are you being, treated for this condition? *
Please explain your rheumatological disorders or autoimmune disease (e.g. lupus, discord lupus, sarcoidosis, psoriatic arthritis) in detail. Have you been, or are you being, treated for this condition(s)? *

Respiratory
Have you experienced any of the following conditions or symptoms? *

Snoring loudly enough to wake your spouse or partner A diagnosis of having asthma, chronic bronchitis, and/or chronic obstructive pulmonary disease (COPD) Very tired during the day despite an adequate amount of sleep A diagnosis of obstructive sleep apnoea No, I have not experienced any of these conditions, events or symptoms
Please explain your asthma, chronic bronchitis, and/or chronic obstructive pulmonary disease (COPD) in detail. Have you been, or are you being, treated for this condition(s)? *

Mental Health
Have you been diagnosed with, been treated formally, experienced or suffer from any of the following conditions or symptoms? *

Depression or major depressive disorder Anxiety or panic disorder Psychiatric condition (e.g. Schizophrenia, bipolar disorder, personality disorder) History of suicidal thoughts or plans to hurt yourself Under a lot of stress currently None of these apply to me Other
Please explain your depression or major depressive disorder in detail. Have you been, or are you being, treated for this condition? *
Please explain your anxiety or panic disorder in detail. Have you been, or are you being, treated for this condition? *
Please explain your psychiatric condition in detail. Have you been, or are you being, treated for this condition? *
Please explain your suicidal thoughts or plans to hurt yourself in detail. Have you been, or are you being, treated for this condition? *
Please explain your stress in detail. Have you been, or are you being, treated for this condition? *
Please explain your mental health condition in detail. Have you been, or are you being, treated for this condition? *
Do you have what you consider to be a good family/friend support system? *

Yes No

Sexual/Reproductive Health
Do you suffer with a difficulty in voiding your bladder (urinating)? *

Yes No
Have you been diagnosed with benign prostatic hyperplasia (prostatic enlargement)? *

Yes No
Please explain your benign prostatic hyperplasia (prostatic enlargement) in detail. Have you been, or are you being, treated for this condition? *

A note on side effects

Deep breath, we've got your back...
- No surprise, but all medical treatments have the potential to cause side effects.
- Once you complete this onboarding process, a doctor will contact you to discuss any potential side effects that may be associated with the use of any of the prescribed medications included in your personalised treatment.
- &BAM offers ongoing doctor care as part of the subscription service. If you've got questions all you need to do is reach out!

Is there anything else you want your doctor to know about your condition or health? *

No Yes
What else would you like to share with your doctor? *
If prescribed, would you like to proceed with &BAM's preferred pharmacy?

Yes, I would like to proceed with a pharmacy in the &BAM network No, I would like to pick my own pharmacy

Quick Identity Verification

We need to verify your identity with a photo of your government-issued ID.
Please take a photo of your driver’s license, ID book/card or passport.

You need to ensure that:
- Your ID is valid
- Your full name and date of birth are visible
Take photo or upload a file:
Upload File

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Genuine ED Treatment Plans, Prescribed Online

Your treatment plan may contain prescription medications designed to treat erectile dysfunction, pursuant to the doctor’s consultation. The specific treatments can only be disclosed after your consultation with the doctor.
At this stage, we just need to know how many uses you think you will need in a month? *
prev next ( X )
4 USES PER MONTH ✔️ Personalised treatment ✔️ Free delivery ✔️ Ongoing doctor care
299 ZAR Plan

6 USES PER MONTH ✔️ Personalised treatment ✔️ Free delivery ✔️ Ongoing doctor care
349 ZAR Plan

8 USES PER MONTH ✔️ Personalised treatment ✔️ Free delivery ✔️ Ongoing doctor care
445 ZAR Plan

👍🏽 Thank You!

You have completed the medical erectile dysfunction assessment.
There is a once-off cost of R150 for the doctor’s consultation (this is refunded if you’re not suitable for &BAM). For &BAM customers, this once-off cost includes all ongoing care, repeat scripting, and doctor check-ups.

Once you process this payment, the doctor will review your submission and contact you within the next 24 hours. You can expect a call between 5 pm and 7 pm on weekdays.
Should be Empty:

Welcome to Your &BAM Erectile Dysfunction consultation

In the last 6 months:

Give social stigma the middle finger.

Please provide your contact details

Next, we're going to dive into your medical history...

Tell us about your ED?

General Medical History

Health and Habits

Rheumatological

Endocrine

Cardiovascular

Respiratory

Mental Health

Sexual/Reproductive Health

A note on side effects

Quick Identity Verification

Genuine ED Treatment Plans, Prescribed Online

👍🏽 Thank You!