Get the Help You Need — Fast, Simple, and Affordable
Call or text Dr. Kaplan anytime if you have questions about which medication is right for you. The flat $79 fee covers everything — no surprise bills. You'll get a coupon and a local pharmacy will fill your prescription (Viagra or Cialis generics) for as little as 30–40¢ per tablet — often ready in under an hour. Treatment is not provided until your intake form is completed and reviewed.
Name
First Name
Last Name
Date Of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
ZIP code for your preferred pharmacy (in Nevada)
Which medication would you like?
*
generic viagra 50 mg
generic viagra 100 mg
generic cialis 10 mg
generic cialis 20 mg
How many tablets would you like? (Enter a number between 1 and 60)
*
Have you ever taken ED medication previously?
*
yes
no
Have you ever experienced a side effect from ED medication?
*
yes
no
Have you ever taken nitroglycerin or heart medications with nitrates?
*
yes
no
Have you had a heart attack, stroke, chest pain, or been told you have aortic stenosis?
*
yes
no
Do you have poorly controlled or uncontrolled high blood pressure?
*
yes
no
Do you have a bleeding disorder, leukemia, or multiple myeloma?
*
yes
no
Do you have severe liver or kidney disease?
*
yes
no
Do you have retinitis pigmentosa or NAION (eye disease)?
*
yes
no
Do you have a history of priapism or Peyronie’s disease?
*
yes
no
If you answered “Yes” to any of the above, please describe briefly:
Please review our
Terms & Conditions and Arbitration Agreement
before proceeding.
*
I have read and agree to the Terms & Conditions and Arbitration Agreement.
My Products
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ED VISIT
Medical Services
$
79.00
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: