Help us Help Erectile Dysfunction Patients (myED app)

1
Have you ever suffered from erectile dysfunction (ED)?* This field is required.
YESNO
2
What describes you best?* This field is required.
Partner / Spouse of an ED patient
Friend of an ED patient
3
Do you feel you know enough about your partner's / friend's / patient's ED problem to answer a few questions on their behalf?* This field is required.If yes, please answer all further questions on their behalf.
YES NO
4
What's your age?* This field is required.
18 - 24 years
25 - 34 years
35 - 44 years
45 - 54 years
55 - 64 years
above 65 years
I prefer not to say
5
Where do you live?* This field is required.
--Others--
Australia
Brazil
Canada
China
Germany
India
Ireland
Italy
Singapore
United Kingdom
United States
6
How would rate your Erectile Dysfunction?* This field is required.
Mild (much less than half of the time)
Moderate (about half of the time)
Severe (much more than half of the time)
7
How important do you rate Privacy (anonymity) with respect to diagnosis?* This field is required.
1
2
3
4
5
Not important
Very important
8
How important do you rate Convenience with respect to ED diagnosis?* This field is required.
1
2
3
4
5
Not important
Very important
9
How important do you rate Speed with respect to ED diagnosis?* This field is required.
1
2
3
4
5
Not important
Very important
10
How important do you rate Supervision by a medical professional with respect to ED diagnosis?* This field is required.
1
2
3
4
5
Not important
Very important
11
How important do you rate Economical Cost with respect to ED diagnosis?* This field is required.With respect to ED diagnosis
1
2
3
4
5
Not important
Very important
12
How important do you rate reliable information on available treatment options with respect to ED diagnosis?* This field is required.With respect to ED diagnosis
1
2
3
4
5
Not very important
Very important
13
Have you taken professional medical help for your erectile dysfunction?* This field is required.
YESNO
14
What type of professional have you consulted thus far?* This field is required.
Medical doctor (family doctor, urologist, etc)
Counselor (sex therapist, psychotherapist, etc)
Others
15
How comfortable are you talking about your ED problem with your Spouse / Partner ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
16
How comfortable are you talking about your ED problem with your Family Doctor ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
17
How comfortable are you talking about your ED problem with a Specialist Doctor (urologist, andrologist, etc) ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
18
How comfortable are you talking about your ED problem with a Counselor / Therapist ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
19
How long did you suffer from erectile dysfunction before seeking professional help?* This field is required.
1 month
2 - 6 months
6 - 12 months
1 - 2 years
2 - 5 years
5 - 10 years
more than 10 years
20
What is the total cost for your ED diagnosis (consultation and medical tests in US$) thus far?* This field is required.Please EXCLUDE treatment cost
I don't know
Less than $150
$150 to $400
$400 to $600
$600 to $1500
More than $1500
21
Do you feel that an objective method of monitoring the effectiveness and progress of your ED treatment can improve your treatment experience?You may choose multiple answers
I don't know
No
Maybe
Yes, it could save time
Yes, it could save cost
Yes, it could help my confidence
22
How long have you suffered from erectile dysfunction?* This field is required.
1 month
2 - 6 months
6 - 12 months
1 - 2 years
2 - 5 years
5 - 10 years
more than 10 years
23
What are your reasons for not seeking professional help yet?* This field is required.Please select all that apply
My ED is not bothering me
Embarrassment
Associated cost
Lack of treatment options
Uncomfortable talking about ED with a doctor
Privacy concerns
I don't have time to see a doctor
I consider ED to be a normal part of aging
I am waiting for my ED to disappear again
24
Are you planning on seeking professional help within the next year?* This field is required.
YESNO
25
How comfortable are you talking about your ED problem with your Spouse / Partner ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
26
How comfortable are you talking about your ED problem with a Family Doctor ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
27
How comfortable are you talking about your ED problem with a Specialist Doctor (urologist, andrologist, etc) ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
28
How comfortable are you talking about your ED problem with a Counselor / Therapist ?* This field is required.
1
2
3
4
5
Very uncomfortable
Very comfortable
29
Would you seek professional help if you had strong indicators on why you are suffering from erectile dysfunction?
YESNO
30
Would you seek professional help if you were provided assistance for booking appointments with local ED specialists?
YESNO
31
Physiological issue(s) present or not* This field is required.(physical problem)
1
2
3
4
5
Very unimportant
Very important
32
Most beneficial type of professional help* This field is required.(e.g. urologist, therapist)
1
2
3
4
5
Very unimportant
Very important
33
Erection parameters* This field is required.(e.g. circumference change, rigidity, duration etc)
1
2
3
4
5
Very unimportant
Very important
34
Likelihood of improvement through lifestyle changes* This field is required.
1
2
3
4
5
Very unimportant
Very important
35
Psyhological component present or not* This field is required.(stress, anxiety, depression, etc)
1
2
3
4
5
Very unimportant
Very important
36
How likely are you going to use such a device before seeing a doctor?Assuming the product is approved by your local medical agency and is safe to use.
1
2
3
4
5
Very Unlikely
Very Likely
37
How would you value such a medical device?* This field is required.
less than $50
$50 - $100
$100 - $200
$200 - $300
$300 - $400
$400 - $600
more than $600
38
Based on the outcome of such a home-based test, how likely will you choose followup assistance from a nearby ED specialist?* This field is required.
1
2
3
4
5
Very unlikely
Very likely
39
Based on the outcome of such a home-based test, how likely will you choose followup assistance from a remote ED specialist at a lower cost ?* This field is required.
1
2
3
4
5
Very unlikely
Very likely
40
Would you like to receive updates about the project?* This field is required.You'll be the first to hear how we will be helping ED patients (and we promise not to send more than 2 emails a year).
YESNO
41
How can we address you?Name
42
What's your email?(we will not share your email with any third party)
example@example.com
43
Finally, do you have any questions, feedback, or personal experiences to share with us?You can also reach us at hello@prognoix.com
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