Welcome to Hydralast

The following questions will help our physicians determine if you're eligible for ED treatment.

Hydralast is contracted with a US licensed telemedicine provider. We respect your data and privacy.

I agree to the Terms & Conditions

0 - Put Your Personal Details

1 - Please select your sex assigned at birth

2 - What state are you in?

3 - Please enter your weight (lbs)

4 - Do you ever have a problem getting or maintaining an erection that is rigid enough for sex?

5 - Do you get erections…

6 - Have you ever been formally treated for ED or tried any medicines, vitamins, or supplements to treat it?

6(a) - Please provide any details related to the treatment.

Include name, dosage, effectiveness, and any side effects.

7 - Have you had a physical exam with a healthcare provider in the past 5 years?

7(a) - Please explain any issues during your last physical exam

8 - Was your blood pressure taken in the past year?

8(a) - What was the value? (Example: 115/72)

9 - Please list any current medicines, vitamins or dietary supplements you take regularly. Please include the dosage.

If taking no dosage, just type none

10 - Do you take any of the following medicines? Select all that apply.

11 - Please list what you’re allergic to

If no allergies, just type none

12 - Please list your medical conditions and any prior surgeries

If no surgeries or medical condition, just type none

13 - Do any of the following cardiovascular risk factors apply to you?

13(a) - Tell us more about your Cardio Vascular risk factors

If no cardio vascular issues, just type none

14 - Do you have or have you previously been diagnosed with any of the following? Check all that apply.

14(a) - Please tell us more about your Diagnoses and treatment(s).

If no diagnoses or treatments, just type none

15 - Do you experience any of the following cardiovascular symptoms? Select all that apply.

15(a) - Please tell us more about your prolonged leg cramps.

16 - Do you use any of the following recreational drugs? Check all that apply.

Severe reactions may result if ED meds are used in conjunction with recreational drugs.

This may affect your eligibility for a prescription

16(a) - Please explain your drug use. How frequently do you use them? When was the last time you used them?

If no Drug use, just type none

17 - Do you have any of the following conditions? Select all that apply.

17(a) - Does your condition prevent you from having sex? Is it painful? Have you sought treatment for this?

If so, what kind of treatment did you receive? Please explain further.

If no condition, just type none

18 - Do you have now, or have you ever had any of the following conditions? Select all that apply

This information helps your doctor provide both effective and safe dosages of medication if appropriate.

18(a) - Please tell us more about your condition(s).

19 - Is there anything else you want your doctor to know about your condition or health?

19(a) - Please enter anything else you want your doctor to know about your condition or health.

If noting, just type none

20 - Please Attach an image.

Hydralast Treatment Pricing
20% off 1st Time Customer & 6 Month Membership
Medication Strength Price* 1st Time Customer 6 Months 20% off
Sildenafil 15 Treatments (1 box) 25 $119.99* $95.99* $575.95*
50 $139.99* $111.99* $671.95*
100 $159.99* $127.99* $767.95*
Tadalafil 15 Treatments (1 box) 5 $139.99* $111.99* $671.95*
10 $159.99* $127.99* $767.95*
15 $179.99* $143.99* $863.95*
  • $50.00 added for 2nd box for total of 30 treatments.
  • $300.00 added for 6-month membership price for 30 treatments each month.
  • Doctor fee $30.00 per prescription (no extra fee for membership).
  • Shipping $12.00 per order.
  • Add $72 to 6-month membership price to ship monthly treatment.