Erectile Function Index Form
Please mark in the form the answers that best describe your condition. When finished tap submit
NOTE: your email is for my eyes only, and will be used to answer you in private
Email address *
How often are you able to get an erection during sexual activity *
Required
How often your erections are hard enough for penetration *
Required
How often are you able to penetrate your partner *
Required
How often are you able to maintain your erection after the penetration *
Required
How difficult is it to maintain your erection to complete the intercourse *
Required
How do you rate your confidence that you could get and keep an erection? *
Required
Alla Brouk, MD
Internal Medicine, Ant-aging, Sexual wellness, PRP & Amnion & Shockwave therapy
Website: http//www.allabrouk.com, Email: info@allabrouk.com , Phone: (646)494-3572
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