Erectile Dysfunction Assessment Form
A detailed preliminary assessment covering your complaint, medical history and the IIEF-5 scale. Your answers are sent via WhatsApp only with your approval.
Privacy: This form runs entirely in your browser. Your answers are not stored on any server; they are only turned into a WhatsApp message when you choose to send it. The result is not a diagnosis — it is a preliminary assessment.
Source scale: IIEF-5 / SHIM (Sexual Health Inventory for Men). This form is for information and preliminary assessment; it does not replace an examination or a diagnosis.