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0330 043 3771

Premature Ejaculation

Premature ejaculation is the most common ejaculation problem. It's where the male ejaculates too quickly during sexual intercourse. Please fill out the form below so that our clinicians can determine if the treatment will be suitable for you to take.

About the Condition and Treatment

To help us understand that this treatment is the right option for you, please answer the following questions. If you get stuck or need any help, you can contact us.

0%

Do you have renal impairment (Kidney Problems)?

Yes

No

Have you ever had an allergic or anaphylactic reaction to tablets containing dapoxetine?

Yes

No

Do you have any severe allergies?
If yes, please describe the allergy/reaction

Please provide details in this box here...

Yes

No

Do you have a history of mania, bipolar disorder or severe depression?

Yes

No

Do you have any problems of galactose intolerance, Lapp lactase deficiency or glucose?galactose malabsorption?

Yes

No

Have you been previously diagnosed with Glaucoma?

Yes

No

Do you have any significant pathological cardiac conditions such as: • Heart failure (NYHA class II-IV) • Conduction abnormalities such as AV block or sick sinus syndrome • Significant ischemic heart disease • Significant valvular disease • A history of syncope.

Yes

No

Do you have hepatic impairment (liver problems)?

Yes

No

Are you taking any drugs for erectile dysfunction?

Yes

No

Have you been diagnosed with premature ejaculation problems?

Yes

No

Do you have any other forms of sexual dysfunction?

Yes

No

Have you ever experienced Orthostatic hypotension?

Yes

No

Do you have epilepsy?

Yes

No

Please list all your current prescription medication including any medication you buy over the counter...

Do you take any current or repeat medicines? (eg. oral asthma tablets) If yes, please list them below...

We are Sorry!

Based on the answers you have provided you are not eligible.

If you believe this to be an error or you would like to discuss this further, please contact us.

< Back to all conditions Contact Us

About Us

Bolt Healthcare Ltd. is a UK Registered Online Pharmacy. As a registered UK pharmacy, we offer you a wide choice of medicines online, some with and some without prescription. We are dedicated to providing exceptional services and top-quality medications.

Bolt Pharmacy, Suite 204A, Business First, Davyfield Rd, Blackburn, Lancashire, BB1 2QY
0330 043 3771
For Sales & Orders:
hello@boltpharmacy.co.uk

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How to check GPhC Registration

Please visit the relevant website here for information about how to check the registration status of the pharmacy and the superintendent pharmacist.

GPhC Registration Number:

GPhC Registered Owner:

Bolt Healthcare Ltd

Superintendent Pharmacist:

Saim Dalvi (2080851)

GPhC Pharmacy Details:

Bolt Pharmacy, Suite 204A, Business First, Davyfield Rd, Blackburn, Lancashire, BB1 2QY

GPhC Prescriptions Supplier:

hello@boltpharmacy.co.uk

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