Spontan Request Details

Important: Spontan is designed for the treatment of erectile dysfunction. A prescription is required and all requests are reviewed by an Australian-registered doctor. Your suitability will be assessed based on your health information.

Your Health Background

Privacy Notice: The information you share will be reviewed by a licensed doctor to assess your suitability for Spontan. It will be securely stored and not shared without your consent.

Medications & Allergies

Important: Knowing your current medications and allergies helps prevent harmful interactions or side effects.

Consent & Acknowledgement

Final Acknowledgement: I confirm that the information I have provided is accurate. I understand that this service does not replace a face-to-face medical consultation and that I may be contacted for further details if required.

Patient Details