Penile Enhancement Assessment | MAMBA Men’s Clinics

1. Your goals

What would you like to discuss? Select all that apply.

Increasing penile girthImproving appearance or symmetry (shaft / scrotum)Understanding treatment optionsOther

If other, please specify in a single sentence (optional)

Preferred location *

Have you previously had penile filler, injections, implants, or surgery?

YesNoUnsure

If yes, describe the procedure or product, approximate date, and any complications (optional)

Do not stop prescribed medication for this application. Select “None of the above” only if no other options apply.

Current medications and supplements, including blood thinners (optional)

Other medical conditions or recent procedures the physician should know about (optional)

Are you able to attend follow-up appointments as recommended?

YesNo

All times are Eastern Time. Our team will confirm availability before arranging your call.

Which days are best for a physician to contact you?

WeekdaysWeekends

Which times work best?

8 a.m. to 4 p.m.4 p.m. to 7 p.m.

Full name *

Email *

Phone number *

Preferred contact method

CallTextEmail

May we leave a voicemail identifying MAMBA Men’s Clinics?

YesNo