Medical Questionnaire Please complete the following medical questionnaire to obtain your custom-tailored protocol from the medical team at Rock Hard Science. Your first name: Your last name: Your email: With a score of 1 to 5, please rate each of the following questions. 1 = Very Low |2 = Low |3 = Moderate |4 = High |5 = Very High How do you rate your confidence that you could get and keep an erection?* 12345 When you had erections with sexual stimulation, how often were your erections hard enough for penetration (entering your partner)? * 12345 During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?* 12345 During sexual intercourse how difficult was it to maintain your erection to completion of intercourse?* 12345 When you attempted sexual intercourse, how often was it satisfactory for you?* 12345 YOUR SCORE: [calculator calculator-815 “radio-1 + radio-2 + radio-3 + radio-4 + radio-5”]