---
title: Telemedicine Erectile Dysfunction Consultation Form Template | Paperform
description: Professional telehealth ED consultation form with symptom assessment, cardiovascular screening, medication review, and treatment preferences. GDPR & SOC2 compliant.
url: "https://paperform.co/templates/telemedicine-erectile-dysfunction-consultation-form"
type: static
generatedAt: "2026-03-28T00:45:22.483Z"
---

[← Back to free form templates](/templates/)    ![Telemedicine Erectile Dysfunction Consultation Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/telemedicine-erectile-dysfunction-consultation-form.png)
    [Preview](https://_preview.paperform.co/ai-template/telemedicine-erectile-dysfunction-consultation-form) [Use this template for free](/create?ai-template=telemedicine-erectile-dysfunction-consultation-form)    [Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/)[Telehealth](/templates/industry/telehealth/)[Pharmacy](/templates/industry/pharmacy/) [Physician](/templates/role/physician/)[Nurse](/templates/role/nurse/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### Confidential Telemedicine Erectile Dysfunction Consultation Form

Erectile dysfunction (ED) affects millions of men worldwide, yet many delay seeking treatment due to embarrassment or inconvenience. This **telemedicine erectile dysfunction consultation form** makes it easier for healthcare providers to offer discreet, accessible ED consultations from the comfort of patients' homes.

#### Why use Paperform for telehealth ED consultations?

Paperform is trusted by over 500,000 teams worldwide and is SOC2 Type II & GDPR compliant, making it ideal for healthcare providers who need secure, professional forms without the complexity of traditional medical software. This template streamlines the entire virtual consultation process, from initial symptom assessment through cardiovascular screening and treatment planning.

**For telehealth providers, urologists, men's health clinics, and primary care physicians**, this form template eliminates the awkward waiting room experience and replaces lengthy paper forms with a streamlined digital intake that patients can complete privately before their video consultation.

#### What makes this ED consultation form effective?

This template is specifically designed to gather the essential clinical information needed for safe, effective ED treatment:

 - **Comprehensive symptom assessment** including onset, severity, and impact on quality of life
 - **Cardiovascular risk screening** to identify contraindications for certain ED medications
 - **Complete medication review** to check for drug interactions
 - **Treatment preference discussion** to align care with patient goals
 - **Medical history capture** including diabetes, hypertension, and other relevant conditions

The form uses conditional logic to show follow-up questions based on patient responses, ensuring you gather detailed information only when clinically relevant. This creates a better patient experience while capturing the medical details you need for informed treatment decisions.

#### Streamline your virtual men's health practice

For **telehealth platforms, online pharmacies offering ED treatment, urologists, and men's health specialists**, this form integrates seamlessly into your existing workflow. Patients complete the intake form before their scheduled video consultation, giving you time to review their history and prepare appropriate treatment recommendations.

The form can be embedded directly on your website, shared via secure link, or sent through patient portals. Submissions can automatically sync with your EHR system, CRM, or practice management software through Paperform's extensive integrations with tools like Google Sheets, Airtable, or via webhook to your custom systems.

#### HIPAA considerations and security

While Paperform is not HIPAA compliant, this template is designed with privacy in mind and can be used for initial consultations where patients understand the communication method. For practices requiring full HIPAA compliance, consider using Paperform for appointment scheduling and non-PHI communications, then conducting the actual medical consultation through your HIPAA-compliant telehealth platform.

All Paperform submissions are encrypted in transit and at rest, with SOC2 Type II certification ensuring enterprise-grade security controls. You can also enable two-factor authentication, set up role-based access controls, and choose data residency options to align with your privacy requirements.

#### Automate follow-up and prescription workflows

Beyond data collection, you can use **Stepper** (stepper.io) to automate what happens after form submission. For example, trigger a workflow that:

 - Sends the submission to your medical review queue
 - Notifies your clinical team via Slack or email based on risk factors identified
 - Creates a patient record in your practice management system
 - Schedules automatic follow-up for prescription renewal or check-in
 - Routes high-risk patients (those with significant cardiovascular concerns) for additional screening

This automation means your clinical staff can focus on patient care rather than administrative tasks, while ensuring no patient falls through the cracks.

#### Payments and subscription management

If you offer direct-to-consumer telehealth services, you can add Stripe, PayPal, or Square payment fields to collect consultation fees, medication costs, or subscription payments for ongoing ED treatment programs. Paperform's calculation engine can handle tiered pricing (for example, different costs for first-time versus follow-up consultations) and even process subscription billing for patients on monthly treatment plans.

#### Customize for your practice

This template provides a comprehensive starting point, but you can easily customize it to match your specific practice needs. Add your clinic logo, adjust the color scheme to match your brand, include educational videos about ED treatment options, or modify questions based on the specific medications you prescribe.

The document-style editor makes customization intuitive—just click and type like you would in a word processor. No coding or design skills required.

#### Who should use this form template?

This ED consultation form template is ideal for:

 - **Telehealth platforms** offering men's health services
 - **Urologists** conducting virtual consultations
 - **Primary care physicians** expanding into telemedicine
 - **Men's health clinics** providing specialized ED treatment
 - **Online pharmacies** with physician consultation services
 - **Wellness clinics** offering comprehensive men's health care

Whether you're a solo practitioner just starting with telehealth or a multi-provider men's health clinic processing hundreds of consultations monthly, this template scales with your practice while maintaining the professional, empathetic approach ED patients deserve.

Start providing convenient, confidential erectile dysfunction consultations today with Paperform's secure, easy-to-use telemedicine intake form.
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