​Bocox™ Erectile Dysfunction & Botulinum Toxin Type A Online Test


​This is a validated questionnaire to help identify men who have a problem with Erectile Dysfunction.
Please select the response that best represents your answer for each of the questions below. While your experiences may change from time to time, what we need to know is your general experience with intercourse.

These Online Tests are simple questionnaires that are submitted to our Doctors to see if Essential Men's Clinic has a solution that is right for you. They are obligation free and absolutely confidential. 
    The IIEF-5 (International Index of Erectile Function-5) is an international questionnaire for identifying Erectile Dysfunction. These questions ask about the effects your erection problems have had on your sex life, over the past 4 weeks. Please answer the following questions as honestly and clearly as possible.

    Find out if we can help you. Please give us further information and our Doctor will respond to you within 24 hours.

Please note that by submitting this form you will be signed up to the Essential Mens Clinic Newsletter. We respect your privacy and you can unsubscribe at anytime.

Our Doctors will to your submission from your given email address.
Your personal details will remain confidential and not disclosed to any third parties.
You have the right to view, change or delete this information on request.
This questionnaire is not comprehensive, and does not replace a full history and physical examination and further information may be necessary on follow-up.
​Due diligence will be exercised for making a thorough assessment.

Opening Hours Remuera

Monday 10-6pm
Tuesday 10-6pm
Wednesday 10-6pm
Thursday 10-6pm
Friday 10-6pm

Not open weekends or public holidays.
Howick hours please contact reception
09 523 5999

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'Confidentiality assured' Dr Mark Morunga