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

Based on your answers, you may have an issue.

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