• Important
  • Premature ejaculation
Our doctors would now like to check your suitability for this product

How did you hear about us?

I confirm the above We are now going to ask you a few questions so that we can give you the best medical care. This takes an average of 5 minutes to complete.

We try our best to help our patients, but sometimes our online service is not able to meet all your needs.

Please be honest and if you are unsure about any of the answers, check these with your GP first.

--I am 18 years old or above
--I am using this service on my own behalf and of my own free will and any treatment or advice is for my sole use only
--I will see my GP if I need help filling out this form, reading or understanding this consultation
--I understand my consultation will not be passed to the Crest Pharmacy Online Doctor clinical team until I have successfully completed payment
--I understand the use of EMLA for PE is "off-label" in men aged over 65 and Regaine® 5% foam is off-label in men aged over 50


We want to offer you high quality, safe care. To do this we need you to be honest with your answers. Serious clinical errors could occur if you don't give us accurate information. Thank you for using our service.

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What is your date of birth?

Please select all that apply to you:


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