40890 Grand River Ave, Novi, MI 48375Novi, MI (248) 987-6182Fax: (248) 987-4963

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Clear Choice Men's Health

Complete Your ED Troche Order

Finish your secure intake for custom compounded ED troches. A licensed provider reviews your information before Clear Choice Pharmacy prepares your prescription.

Michigan patients only

Clear Choice Pharmacy is currently licensed to dispense only in Michigan. Out-of-state patients cannot complete checkout or clinical intakes until we expand with our telehealth partner.

You will get a phone call from (248) 987-6182 from our physicians to complete your clinical review.

Step 2 of 4

Your information & health profile

Complete required fields so your provider can review safely

Your order

Sildenafil + Tadalafil

Dual-Action Combination

Billing: Annual

$49/mo · $588 due upon approval

Prescription required after clinician review. Payment is authorized as a hold and captured only if approved.

Michigan patients only

Clear Choice Pharmacy is currently licensed to dispense only in Michigan. Out-of-state patients cannot complete checkout or clinical intakes until we expand with our telehealth partner.

Demographics

First Name *

Last Name *

Email *

Phone *

Date of Birth *

State *

Michigan patients only

Street Address

City

ZIP Code

Cardiovascular Vitals

Blood Pressure Requirements

For your safety, we require recent blood pressure readings. If your BP is below 90/50 or above 170/100, we cannot proceed with online treatment.

Systolic (top number) *

Diastolic (bottom number) *

Heart Rate (BPM)

When was your blood pressure last checked?

Safety Screening

Critical Safety Questions

These conditions are absolute contraindications for ED medications. Check any that apply to you. If none apply, check the confirmation at the bottom of this section.

I take nitrates (nitroglycerin, isosorbide) for chest pain or heart problems

Including patches, sprays, or pills

I take Riociguat (Adempas) for pulmonary hypertension

I have had a heart attack in the past 90 days

I have had a stroke in the past 6 months

I have severe heart failure

I have unstable angina or chest pain at rest

None of the above apply to me *

Medical History

Do you have diabetes?

No

Yes, Type 1

Yes, Type 2

Prediabetes

Do you have high blood pressure (hypertension)?

No

Yes, controlled with medication

Yes, not well controlled

Do you have any heart conditions?

No

Yes, stable/managed

Yes, recent issues or hospitalization

List all current medications

Known allergies

Treatment Goals

How long have you experienced ED symptoms? *

Less than 6 months

6-12 months

1-3 years

More than 3 years

How would you rate the severity of your ED? *

Mild - Occasional difficulty

Moderate - Frequent difficulty

Severe - Unable to achieve or maintain erection

What are your treatment goals? (Select all that apply)

Stronger erections

Longer-lasting erections

Faster onset of action

More spontaneity

Improved confidence

Better relationship satisfaction

Any additional concerns or information for the physician?

Your Privacy is Protected

HIPAA Compliant

Your information is protected by federal healthcare privacy laws

256-bit Encryption

Bank-level security for all personal and medical data

Review time

Dr. Dourra usually takes 4–5 days to review your intake.

How It Works

1Review your selected troche formulation
2Complete the secure medical questionnaire
3Upload ID and authorize payment hold
4Dr. Dourra usually takes 4–5 days to review your intake.
5After payment is received, processing and shipping take about 5 business days.

Need Help?

Our team is available to answer questions about the checkout process.

(248) 987-6182 info@clearchoicepharmacy.com

40890 Grand River Ave
Novi, MI 48375 (248) 987-6182

Fax: (248) 987-4963

Michigan pharmacy focused on provider-guided medical weight management and GLP-1 care, with full-service prescriptions and compounding.

Medical Weight Loss

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