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* Note Fill Out The Health Form Below & A State Licensed EDTMax Health Care MD Prescriber Will Review It Within 8 Hours. If The Prescriber Has Any Further Questions They Will Contact You By E-Mail.

Have you maintained an erection satisfactorily the last 2 times?
Have you used or taken any ED treatments in the past?
Have you experienced any side effects to ED treatments you have taken?
Do you have any allergies?
Please Enter Your CC #, Expiration Date, 3 Digit Code on the back of your card. Be sure to provide the correct billing address. Your Credit Card will not be billed, unless a MD Prescriber approves your Health Questionnaire.  You can let us know how many refills when we contact you at the number you leave. You Can Also Call us at 929-441-8903 To Answer The Questions and Give US your Card Over The Phone. We Can Fill in the Questionnaire for you. Our Email is EdTmaxHelp@Gmail.com

Thanks for submitting! A Licensed MD will Review Usually Within 3 Hours

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