Step 1 — About You

Let's start with
the basics

This stays between you and your doctor. We don't share it with anyone, ever.

Full Name *

Please enter your full name.

Age *

Must be 18–80 years old.

Mobile Number *

▼

Enter a valid mobile number.

Email Address *

Enter a valid email address (e.g. juan@email.com).

Delivery Address *

Delivered in plain, unbranded packaging. No Zeal branding visible outside.

Please enter your delivery address.

Step 2 — Health Background

Your medical history

Just be honest here — it helps your doctor take better care of you. No judgment, promise.

Are you currently taking nitrates? *

E.g. nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, amyl nitrite ("poppers")

Yes

No

⛔

Unable to proceed

ED medication cannot be safely combined with nitrates. This can cause a severe, life-threatening drop in blood pressure. Please consult your cardiologist for alternative options.

Are you taking riociguat (Adempas)? *

Used for pulmonary hypertension

Yes

No

⛔

Unable to proceed

ED medication cannot be safely combined with riociguat. Please consult your physician for alternatives.

Heart attack, stroke, or cardiac procedure in the last 6 months? *

Yes

No

⚕ Our doctor will evaluate your cardiac history carefully before making any recommendation.

Do you have high blood pressure? *

Yes

No

Do you have diabetes? *

Yes

No

Severe liver or kidney disease? *

Yes

No

⚕ Liver or kidney conditions affect how medication is processed. Our doctor will evaluate carefully.

Antifungals or HIV medications? *

E.g. ketoconazole, itraconazole, ritonavir, saquinavir

Yes

No

⚕ These medications can significantly affect ED medication levels. Our doctor will adjust dosing carefully.

Serious eye conditions or recent eye surgery? *

E.g. retinitis pigmentosa, NAION, glaucoma

Yes

No

⚕ Certain eye conditions require careful evaluation before prescribing. Our doctor will review your case.

Do you smoke or vape? *

Yes

Former

Vape only

No

Known drug allergies? *

Yes

None known

Current medications

Include vitamins, supplements, herbal medicines. Write "none" if not applicable.

Step 3 — Your Experience

Tell us what
you're experiencing

There's no wrong answer. Just tell us what's going on, so your doctor knows how to help.

How long have you been experiencing this? *

Less than 3 months

3 to 12 months

More than 1 year

How would you describe the severity? *

Mild

Occasional difficulty — most encounters are still successful

Moderate

Difficulty about half the time

Severe

Significant difficulty most of the time

Do you still get morning erections?

Yes — regularly

Sometimes

Rarely

No — not at all

How much alcohol do you consume per week?

None

1–7 drinks per week

Moderate

8 or more drinks per week

Heavy use can worsen ED

Have you tried ED treatment before?

Yes

No — first time

Anything else your doctor should know?

Step 4 — Your Treatment

Based on your answers,
here's our recommendation

Here's what we'd guess is right for you. Your doctor will double-check before anything's final.

Daily ED Medication

Always ready. No planning required.

Taken once daily — stays in your system continuously so you're always ready. No timing pressure. No planning. Just confidence, every day.

₱1,800 / month

On-Demand ED Medication

Take it when you need it.

Taken 30–60 minutes before intimacy. Fast-acting, lasts 4–6 hours. Ideal if you prefer flexibility over a daily routine.

₱1,200 / month

Not sure? Your doctor will confirm the best option after reviewing your answers. You can also switch treatments after your first month — no penalty.

Step 5 — Consent & Waiver

Review & sign

Almost done. Take a minute to read through this — then we're good to go.

I have read, understood, and agree to all terms above — including the Telemedicine Consent, Informed Consent for ED Medication, Data Privacy (RA 10173), Subscription Terms, and Patient Rights. I confirm all health information I provided is accurate and complete.

Type your full name to confirm *

This serves as your electronic signature under RA 8792 (E-Commerce Act of the Philippines).

⚠ Critical Safety Reminder

ED medication must NEVER be combined with nitrates or riociguat. In case of any medical emergency, call 911 or go to the nearest hospital immediately.

✓

Assessment received

A licensed Zeal physician will personally review your case within 24 hours and reach out via the contact details you provided.

ZHL-20250629-0001

01A licensed physician reviews your assessment within 24 hours.

02You'll receive a Viber or SMS message with payment instructions if approved.

03Once payment is confirmed, your medication is dispensed and shipped within 24 hours.

04Delivery in plain, unmarked packaging within 1–3 business days.

Save your reference number above. We will contact you via Viber or SMS within 24 hours.

Let's start withthe basics