ED Quiz

1

How would you rate your confidence you can get and keep an erection? * This field is required.

Very low

Low

Moderate

High

Very high

4

How often are your erections hard enough for penetration* This field is required.

No sexual activity

Almost never or never

A few times (less than half)

Sometimes (half the time)

Most times

Almost always or always

5

During sexual intercourse, how often were you able to maintain your erection after entering your partner?* This field is required.

Did not attempt

Almost never or never

A few times

Sometimes

Most times

Always

6

During sexual intercourse, how difficult is it to maintain your erection to completion?* This field is required.

Did not attempt

Almost never or never

A few times

Sometimes (half the time)

Most times

Always

7

When attempting sexual intercourse, how often is it satisfactory to you?* This field is required.

Never

A few times

Sometimes

Most times

Always

8

Your Score

9

The following best describes me:* This field is required.

I am financially able to invest to solve my problem

I might be able to invest to solve my problem

I do not have the finances to invest to solve my problem

10

On a scale of 1 - 4, how important is solving this problem?* This field is required.

Low priority

Thinking about it

Motivated to take action

I want it solved yesterday

11

Committment

12

Email* This field is required.

example@example.com

13

Name* This field is required.

First Name

Last Name

14

Cellphone Number* This field is required.

Area Code

Phone Number

15

SEND ME MY SCORE! I agree to check my inbox to review my score and take my next steps.