It's a real review, not a formality
Once you submit the health questionnaire, it goes to an independent, licensed U.S. physician — not an algorithm, and not a rubber stamp. They're reading for a specific set of red flags, and the questionnaire is built around surfacing them.
The single most important question: nitrates
Sildenafil and tadalafil both interact dangerously with nitrate medications — the kind prescribed for chest pain, like nitroglycerin — and with amyl nitrite ("poppers"). Combined, they can drop blood pressure to a dangerous level. This is the number one reason a physician declines a prescription, and it's non-negotiable regardless of how mild the rest of your history looks.
What else gets checked
Beyond nitrates, the physician is looking at your broader heart history, blood pressure, any other ED medications you're currently taking, and a handful of other prescription and OTC medications known to interact with PDE5 inhibitors. This is exactly why the questionnaire asks for everything you take — not just the things that feel relevant.
If you're not approved
Declines happen, and they're not rare. If the physician determines the medication isn't appropriate for you, you are not charged — the review itself costs nothing whether or not it results in a prescription. In many cases they'll point you toward what to discuss with your own doctor instead.
If you are approved
The prescription is sent straight to our accredited U.S. pharmacy partner, which fills it and ships it in unmarked packaging — usually within a day of approval, with delivery landing 3–5 business days after that.
Full detail on timing and what's in the box is on the shipping policy page. Specific questions about eligibility are answered on the FAQ.