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PATIENT REQUEST FORM

TAILORED GUIDANCE FOR MEN’S SEXUAL HEALTH

Struggling to find accurate or useful information and options for male sexual function issues? The Penile Rehab Protocol by ConsultRX offers personalized, root-cause-focused solutions nationwide. Fill out this form for expert guidance without any obligations, tailored for your well-being.

Please don’t forget to fill out the form fields, check the agreement box, and hit submit, but you can also reach us via email at: consults@revelationpharma.com

Thank you for your interest in ConsultRX and we look forward to speaking with you soon!