• This online form for Viagra Connect will save you time on your visit to McFadden’s Pharmacy. If you request the pharmacist to call you, most of the consultation can occur by phone before you visit the store. Otherwise, the pharmacist will have your form ready and they will have a private consultation with you in the store. This takes a few minutes to complete.
  • This product is only available to men aged 18 or over. (If you are under 18 please contact your GP to discuss your options)
  • Viagra Connect is only intended for use in men who are experiencing erectile dysfunction (ED) i.e. difficulty in getting and/or maintaining an erection satisfactory for sexual performance.


  • GENERAL HEALTH

    Has your doctor advised that you are not fit enough for any physical and/or sexual activity?



  • Do you feel very breathless or experience chest pain with light or moderate physical activity, such as walking briskly for 20 minutes or climbing two flights of stairs?


  • Have you had a heart attack or stroke within the last 6 months?


  • Do you have any other heart problems or are you under a doctor’s care for any of the following:
    Low blood pressure or uncontrolled high blood pressure
    Unstable angina (chest pain), irregular heart beat or palpitations (arrhythmia)
    A problem with one of the valves in your heart (valvular heart disease)
    A problem where the heart muscle becomes inflamed and does not work as well as it should (cardiomyopathy)
    Heart problems causing blood flow issues (e.g. left ventricular outflow obstruction, aortic narrowing) or severe cardiac failure



  • OTHER INFORMATION

    Some men are on medication or have certain health conditions that could make Viagra Connect unsafe to take. The following questions help the pharmacist establish if Viagra Connect is suitable for you.

  • Please enter a full list of all regular medication on this form or bring a list with you when you come to the pharmacy.


  • Are you using drugs called ‘poppers’ for recreational purposes (e.g. amyl nitrite)?


  • Do you have Peyronie’s disease or any other deformation of the penis?


  • Have you ever had loss of vision because of damage to the optic nerve (such as non-arteritic anterior ischaemic optic neuropathy [NAION]) or have an inherited eye disease (such as retinitis pigmentosa)?


  • Do you have any other illnesses, medical conditions, or allergies?



  • What pack size do you require?


  • WHAT HAPPENS NEXT?

    Once you click submit, the pharmacy will receive your details. The pharmacist will review the information you have provided. If you request a phone consultation by entering your phone number below the pharmacist will call you to carry out most of the consultation over the phone. Your medication will be ready for collection within 1 hour (during store opening hours). You will still need to come to the pharmacy yourself to collect the medication.

  • CONTACT PHONE NUMBER

    By entering your phone number here, you are consenting to the pharmacist contacting you by phone to carry out a consultation. (If you do not consent to being contacted and want to complete the consultation in store, please leave this question blank)