Treatment Quiz Home Page AU

What category are you looking to treat?

Lead Source

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Lead Status

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Lead Method

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UTM_source

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UTM_medium

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UTM_campaign

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GCLID

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UTM_term

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UTM_content

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1

Erectile Dysfunction

2

Premature Ejaculation

3

Erectile Dysfunction and Premature Ejaculation

4

Weight Loss

5

Hormone Restoration

Do you have trouble maintaining an erection strong enough for penetration?

1

Always

2

Sometimes

3

Never

On a scale of 1 to 10, how weak is your erection?

How long has this been a problem for you?

1

Less than 6 months

2

6 to 12 months

3

12 months to 3 years

4

3 years plus

Are you able to satisfy your partner during sex?

1

Always

2

Sometimes

3

Never

During intimacy, do you feel anxious or fear ejaculating too early?

1

Yes

2

No

Do you avoid intimacy because you feel you’re not satisfying your partner?

1

Yes

2

No

3

Sometimes

Do you have heart issues?

1

Yes

2

No

Do you have diabetes?

1

Yes

2

No

What is your age group?

1

20 to 25 years

2

26 to 35 years

3

36 to 45 years

4

46 to 55 years

5

56 years or older

Do you experience morning erections?

1

Yes

2

No

3

Sometimes

Do you avoid having sex with your partner due to fear and/or embarrassment?

1

Yes

2

No

How long has this been a problem for you?

1

Less than 6 months

2

6 to 12 months

3

12 months to 3 years

4

3 years plus

What is your age group?

1

20 to 25 years

2

26 to 35 years

3

36 to 45 years

4

46 to 55 years

5

1

Yes

2

No

Are you seeking convenience and privacy?

1

Yes

2

No

How long has this been a problem for you?

1

Less than 6 months

2

6 to 12 months

3

12 months to 3 years

4

3 years plus

What is your age group?

1

20 to 25 years

2

26 to 35 years

3

36 to 45 years

4

46 to 55 years

5

56 years or older

Are you looking for a short-term solution or a long term fix?

1

Short Term (Band-Aid)

2

Long Term (Beat It)

How much weight would you like to lose in the next 6 - 12 months?

1

5KG

2

10 - 15KG

3

1

Less than 6 months

2

6 to 12 months

3

12 months to 3 years

4

3 years plus

What is your age group?

1

20 to 25 years

2

26 to 35 years

3

36 to 45 years

4

46 to 55 years

5

56 years or older

Are you looking for a short-term solution or a long-term fix?

1

Short-Term (Band-Aid)

2

Long-Term (Beat It)

Have you tried any treatments before?

1

Yes

2

No

Did the treatment work for you?

1

Yes

2

No

3

Sometimes

Have you had a history of low testosterone?

1

Yes

2

No

Are you overweight?

1

Yes

2

No

Do you have sleep issues?

1

Yes

2

No

Do you have any blood test results from the last 3 months?

1

Yes

2

No

First Name

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Last Name

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Email Address

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This self assessment is for informational purposes only and not a medical opinion. In an emergency, call your local emergency number. By submitting, you consent to Menova colecting and storing your information to provide the best possible service and confirm you have read our terms and conditions and privacy policy.

What category are you looking to treat?

Do you have trouble maintaining an erection strong enough for penetration?

On a scale of 1 to 10, how weak is your erection?

How long has this been a problem for you?

Are you able to satisfy your partner during sex?

During intimacy, do you feel anxious or fear ejaculating too early?

Do you avoid intimacy because you feel you’re not satisfying your partner?

Do you have heart issues?

Do you have diabetes?

What is your age group?

Do you experience morning erections?

Do you avoid having sex with your partner due to fear and/or embarrassment?

How long has this been a problem for you?

What is your age group?

Have you tried any medicine?

Did the treatment work for you?

Are you sexually active?

Would you consider yourself overall healthy?

Do you consider yourself health concious?

Do you have heart issues?

Are you seeking convenience and privacy?

How long has this been a problem for you?

What is your age group?

Are you looking for a short-term solution or a long term fix?

How much weight would you like to lose in the next 6 - 12 months?

Have you tried any weight loss medications or treatments before?

Did the treatment work for you?

Would you consider yourself overall healthy?

How long have you been feeling "off" or not yourself?

What is your age group?

Are you looking for a short-term solution or a long-term fix?

Have you tried any treatments before?

Did the treatment work for you?

Have you had a history of low testosterone?

Are you overweight?

Do you have sleep issues?

Do you have any blood test results from the last 3 months?

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