Welcome to your Premature Ejaculation Check-up

Find out more about your health condition and the related services we offer, by completing in a simple health assessment.

*This questionnaire is for reference only. It is not a medical diagnosing tool.

Please answer the questions based on your situation in the recent four weeks

Your Name
Phone No.
Your Email
1. How is your sexual libido or interest?
2. Is your erection rigid enough for sexual intercourse?
3. Can you maintain erection until the end of sexual intercourse?
4. What is the duration from penis penetration to ejaculation?
5. How difficult is it to prolong the sexual intercourse?
6. Are you satisfied with your sexual life?
7. Is your partner satisfied with her sexual life?
8. Does your partner reach orgasm during sexual intercourse?
9. How is your confidence in completing sexual intercourse?
10. Do you feel anxious, depressed or stressful during sexual intercourse?