About Us EnglishAgeWeightHeightGender / Sex Male Female OtherHow would you describe your physical activity level? Sedentary (little or no exercise) Light activity (1-3 days/week) Moderate activity (3-5 days/week) Very active (6-7 days/week)Do you smoke? Yes No Frequently (1-2 times a week)Do you use tobacco products or Gutkha? Yes NoHow often do you consume alcohol? Never Occasionally Frequently (1-2 times a week) DailyHow many hours of sleep do you get each night? Less than 5 hours 5-6 hours 7-8 hours More than 8 hoursDo you suffer from health issues like anxiety or depression? Yes No SometimesMarital Status Single Married Divorced OtherDo you experience difficulty in getting or maintaining an erection? Never Sometimes Frequently AlwaysDo you experience premature ejaculation? (Discharge in very short time) Never Sometimes Frequently AlwaysHave you noticed a decrease in your sex drive (libido)? Not at all Slightly Moderately SignificantlyHow often do you feel fatigued or lack energy during sexual activity? Never Sometimes Frequently AlwaysDo you have any diagnosed medical conditions? High blood pressure Diabetes Heart disease Other (please specify in the end under additional information) NoAre you currently taking any medications for sexual health issues? Yes No SometimesNumeric FieldNumeric Field
