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Question 1 of 10

Which best describes your situation?

Question 2 of 10

How long have you suffered from erectile dysfunction?

Question 4 of 10

How confident do you feel that you could get and keep an erection?

Question 4 of 10

When you had erections, how often were they hard enough for sex?

Question 4 of 10

Were you able to maintain your erection after penetration?

Question 4 of 10

Were you able to maintain your erection until orgasm?

Question 4 of 10

Is your sex life satisfactory?

Question 8 of 10

Have you tried any of the following ED treatments?

Question 9 of 10

Would you like to be contacted by a nurse?

Question 10 of 10

Please enter your information to get your results and receive a call from a nurse.

By providing my contact information, I agree to the Coloplast Privacy Notice, including contact by phone (including my cell phone if that is the number I provided), text message (sms), and email. I understand that I can unsubscribe at any time if I do not want to receive communication from Coloplast and the Privacy Notice provides unsubscribe instructions.


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Question 10 of 10

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This helps us provide specialists in your area and events near you.
Please enter a valid zip code.

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