Dripology

What state do you live in?

We need this to match you with a licensed provider in your state.

What is your current height and weight?

Required by the prescribing physician.

Feet
Inches

Your BMI Result

Underweight <18.5 Normal 18.5-24.9 Overweight 25-29.9 Obese ≥30

How would you describe your erectile dysfunction?

This helps us determine the right treatment for you

I can never get an erection
I can get an erection but can't maintain it
I occasionally have difficulty
I want to improve my performance

How long have you been experiencing these symptoms?

Less than 3 months
3-6 months
6-12 months
More than 1 year

Do you have higher or lower than normal blood pressure?

No
Yes

What is your most recent blood pressure reading?

You can check at a pharmacy or with a home monitor

Do any of these apply to you?

These conditions may affect your eligibility for ED medication

None of the below
Heart attack in the last 90 days
Stroke in the last 6 months
Unstable angina or chest pain during sexual activity
Heart failure
Uncontrolled high blood pressure
Low blood pressure (below 90/50)
Heart arrhythmia
History of heart surgery, stenting, or bypass
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Do you take any nitrate medications?

This is critically important — nitrates combined with ED medication can cause a dangerous drop in blood pressure

None of the below
Nitroglycerin (tablets, patches, or spray)
Isosorbide mononitrate (Imdur)
Isosorbide dinitrate (Isordil)
Amyl nitrite or "poppers" (recreational)
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Do you take any of these prostate or blood pressure medications?

These may require a lower starting dose

None
Tamsulosin (Flomax)
Doxazosin (Cardura)
Terazosin (Hytrin)
Alfuzosin (Uroxatral)
Prazosin (Minipress)

Do any of these apply to you?

These conditions increase the risk of priapism (prolonged erection)

None of the below
Sickle cell disease
Multiple myeloma
Leukemia
Peyronie's disease (penile deformity)
History of priapism (erection lasting over 4 hours)
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Have you experienced any of the following?

These may affect your eligibility

None of the below
Sudden loss of vision in one or both eyes
Non-arteritic anterior ischemic optic neuropathy (NAION)
Retinitis pigmentosa
Sudden decrease or loss of hearing
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Do you have any liver or kidney conditions?

No
Mild liver or kidney issues
Severe liver or kidney disease
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Are you currently taking any medications?

Include prescriptions, supplements, and over-the-counter medications

No, I don't take any medications
Yes, I take medications

Have you used ED medication before?

No, this is my first time
Yes, I have used ED medication

Has a doctor ever told you that sexual activity is unsafe for you?

No
Yes
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Sexual Health Inventory for Men (SHIM) — pick the range that best describes you

The SHIM is a 5-question instrument scored 5–25; lower scores indicate more severe ED. Pick the range that matches your overall confidence and ability over the past 6 months.

22–25 — no ED
17–21 — mild ED
12–16 — mild-to-moderate ED
8–11 — moderate ED
5–7 — severe ED

Is running or walking difficult for you?

Cardiovascular fitness affects whether sexual activity is safe at typical exertion levels.

No
Yes

Are you currently receiving chemotherapy?

No
Yes

Have you ever had an adverse or allergic reaction to ED medications or their ingredients?

No
Yes
Based on your selection, you may not be eligible for this treatment. A provider will review your information and follow up with you.

Anything else you'd like your doctor to know?

Share any additional information, questions, or concerns.

This is optional - only include what you think is important

How would you prefer to take your medication?

Your doctor will confirm the best option for you

As needed before sexual activity (works up to 36 hours)
Daily low dose for spontaneous readiness
I'm not sure — let my doctor decide

Upload a photo of the front of your government-issued ID.

Driver's license, state ID, or passport. Required for prescriber identity verification.

📸
Tap to take or upload a photo
(JPG, PNG, WEBP, or PDF — HEIC not supported)

Upload a selfie holding your ID.

Hold your ID up next to your face so your prescriber can confirm the ID is yours.

📸
Tap to take or upload a photo
(JPG, PNG, WEBP, or PDF — HEIC not supported)