Sexual Health Treatments

1
What is your full name?* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
Confirm Email
3
Phone Number* This field is required.
Please enter a valid phone number.
4
What is your date of birth?* This field is required.
Date
Month
Day
Year
5
Age ?
6
What is your sex assigned at birth?* This field is required.
Male
Female
7
What is your mailing address?* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
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Other
Country
8
What type of erectile dysfunction solution do you prefer?* This field is required.
Fast-acting (Viagra-like)
Long-lasting (Cialis-like)
Combined Effect (Viagra + Cialis)
9
Do you use recreational drugs?* This field is required.
YESNO
10
Have you been experiencing increased stress or anxiety?* This field is required.
YESNO
11
How often do you consume alcohol?* This field is required.
Please Select
Please Select
Never
Occasionally
Regularly
12
Do you smoke?* This field is required.
YESNO
13
Do you have any allergies to medications?* This field is required.
YESNO
14
Please list any medication allergies* This field is required.
15
Are you currently taking any medications?* This field is required.
YESNO
16
Please list your current medications, including over-the-counter and supplements* This field is required.
17
What strength of erectile dysfunction (ED) solution are you interested in?* This field is required.
Please Select
Please Select
Low
Medium
High
Ultra
18
How often do you experience erectile dysfunction?* This field is required.
Please Select
Please Select
Rarely
Sometimes
Often
Always
19
How long have you been experiencing erectile dysfunction?* This field is required.
Please Select
Please Select
Less than 6 months
6-12 months
1-2 years
More than 2 years
20
Do you have any of the following medical conditions?* This field is required.
Diabetes
High Blood Pressure
Heart Disease
None of the above
21
Total Score
22
Recommended Treatment ( Sildenafil )
23
Recommended Treatment ( Tadalafil )
24
Recommended Treatment ( Vitality Max Low )
25
Recommended Treatment ( Vitality Max Medium )
26
Recommended Treatment ( Vitality Max High )
27

Medication for females is currently unavailable. We will notify you as soon as it becomes available.

Thank you for choosing joey med!
28
What specific sexual health issue are you experiencing?
Low Libido
Hormonal Imbalance
29
Have you been experiencing increased stress or anxiety?* This field is required.
YESNO
30
Are you experiencing irregular periods or other menstrual cycle issues?* This field is required.
YESNO
31
Do you experience frequent mood swings?* This field is required.
YESNO
32
Do you often feel fatigued or low on energy?* This field is required.
YESNO
33
FemLibido Boost
34
Estro Balance
35
Signature* This field is required.I confirm that my signature on file is valid in place of signing here.
Clear
36
Terms and Conditions* This field is required.
37
We're sorry, but our services are currently only available to residents of Florida.
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