Are you male aged between 18 - 64?
Does premature ejaculation cause you personal distress or inter-personal difficulty with your partner?
Do you drink alcohol?
Do you suffer any pain whilst ejaculating, or do you have any difficulty or pain passing urine?
Do you ejaculate before you want to?
Does it take you less than 2 minutes to ejaculate after penetration?
Have you been suffering from premature ejaculation for more than 6 months?
Do you find it difficult to achieve or maintain an erection before ejaculation?
Do you have low blood pressure (below 90/50)?
Do you have a tendency to faint or get light-headed when you stand up from a lying position?
Are you allergic (hypersensitive) to Priligy or dapoxetine?
Have you ever suffered from any of the problems listed below?
Are you taking any of the following medications?
Do you understand that if you experience any side effects of treatment such as changes in mood or any seizures, you must discontinue treatment immediately and seek urgent medical attention from a doctor?
Do you understand that if you feel light headed soon after standing, you should immediately lie down so your head is lower than the rest of your body or sit down with your head between your knees until the symptoms pass? You should also ensure you do not rise too quickly after prolonged lying or sitting and do not drive or operate machinery if you experience these symptoms.
Do you agree to the following?