Private Pre-Assessment
Evaluation Form
Start with a private preliminary review for men's health concerns. This form helps our medical team understand your history, available reports and treatment expectations before a personalized pathway is planned.
A clear first step for a new beginning
The questions below are designed to organize the first medical information needed for an erectile dysfunction pre-assessment. They help identify possible arterial insufficiency, separate hormonal or neurogenic factors, and support faster specialist review.
Share your identity, medical history and previous treatment details.
Add Doppler, hormone and clinical findings if they are available.
Our team reviews suitability before any treatment planning begins.