Men’s Wellness Assessment

What brought you to us today?

Erection problems Ejaculation problems Sexual urge problems Size problems I don’t know, I’m just not feeling it

Enter your Phone Number

What is your frequency of sexual intercourse?

Never 1-3 times a month 1-3 times a week Almost daily

Do you masturbate?

Yes No

Have you ever taken any prior medication or consultation for the issue you are facing?

Yes No

Physical Health & Relations

Congrats! You're halfway there! Simply respond to a few more questions about your relationships.

Your BMI Score

Check Your BMI Score

BMI < 18.5 BMI 18.5 - 25.9 BMI > 26

What is your current relationship status?

Single Dating/In a relationship Married (No kids) Married (With kids) Widowed/Divorced

Do you feel this issue is because of:

Size issue Frequent Masturbation Interpersonal relationship issues Performance anxiety Hectic work life

Do you have any Physical Illnesses? (Diabetes/Hypertension/Thyroid etc)

Yes No

What result are you looking for? (Select multiple)

To increase the timing To increase the sexual urge To increase size To increase fertility To increase performance

Lifestyle

Now, it's time for some lifestyle related questions!

Do you Smoke/Consume tobacco products?

Yes No Socially

Do you consume Alcohol?

Yes No Socially/Occasionally

What is your exercise routine?

Never do it Some days a week whenever I get time Daily without fail

Submit Your Responses

Name: Email: I agree to the Privacy Policy.

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What brought you to us today?

Enter your Phone Number

What is your frequency of sexual intercourse?

Do you masturbate?

Have you ever taken any prior medication or consultation for the issue you are facing?

Physical Health & Relations

Your BMI Score

What is your current relationship status?

Do you feel this issue is because of:

Do you have any Physical Illnesses? (Diabetes/Hypertension/Thyroid etc)

What result are you looking for? (Select multiple)

Lifestyle

Do you Smoke/Consume tobacco products?

Do you consume Alcohol?

What is your exercise routine?

Submit Your Responses

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