AMI-SCI Treatment Options for Spinal Cord Injured Men

TREATMENT OPTIONS

FIND OUT WHAT TREATMENT IS RIGHT FOR YOU

To find the most successful treatment option for you, please tell us about your medical history.
Doctor will contact you at your convenience for a private phone consultation.
The information you give us is completely confidential. (* = required fields)

Contact Details

First Name *
Last Name *
Email *
Phone *
Mobile
Address *
Suburb *
State *
Postcode *
Country *
D.O.B. (dd/mm/yyyy) *	select
Occupation

Medical Conditions

Sexual Activity

How often do you have sexual intercourse per month?
How often would you like to have sexual intercourse per month?
Are you in a relationship?	Yes No
If Yes, how long have you been together?
Are you seeking treatment for?	Getting an Erection Keeping an Erection

Medication

Appointment

	For your FREE CONSULTATION WITH DOCTOR in the convenience and privacy of your own home or office, choose a day that suits you, either morning or afternoon and doctor will phone you then, to discuss suitable treatment options We will send you an email to confirm your appointment. Pick the day (dd/mm/yyyy) * select Pick morning or afternoon *

This website is intended for Australian and New Zealand residents only.

Have you been advised by a doctor NOT to have sexual intercourse? *	Yes No
Does your penis have a curve that has developed over time? *	Yes No
What is your Level of Lesion? *
Have you ever experienced Autonomic Dysreflexia? *	Yes No
Date of Injury (mm/yyyy)	select
Cause of Injury
What is your bladder care method?
If other please specify
Which of the following conditions do you suffer from?	Quadriplegia (spinal cord injury/disease) Paraplegia (spinal cord injury/disease) Partial Paralysis Multiple Sclerosis Spina Bifida Cerebral Palsy Muscular Dystrophy/Atrophy Amputee Arthritis Polio Hemiplegia Parkinsons Disease Stroke/CVA (Cerebral Vascular Accident) Brain Injury Intellectual/Developmental Alzheimers Incontinence Condition Cancer Diabetes High Blood Pressure Depression Prostate Condition Peyronies Disease Scar tissue (hard lumps) in your penis
Other Disability/Condition (please specify)

Please list medications you are currently taking.
Please list any medications you are allergic to.
Do you take Nitrates? *	Yes No
Which of the following erection medicines have you tried?
Caverject® (Prostaglandin Injection) *	Yes No
How Long?
How Frequently?
Result?
Injection (that mat contain Atropine/Phentolamine/Prostaglandin/Papaverine) *	Yes No
How Long?
How Frequently?
Result?
Levitra® (Vardenefil tablet) *	Yes No
How Long?
How Frequently?
Result?
Cialis® (Tadalafil tablet) *	Yes No
How Long?
How Frequently?
Result?
Viagra® (Sildenafil tablet) *	Yes No
How Long?
How Frequently?
Result?
Nasal Spray (that may contain Apamorphine/Phentalomine) *	Yes No
How Long?
How Frequently?
Result?