Sexual Activity Inventory

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* 1. Has your sexual behavior ever created problems for you?

Yes

No

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* 2. Has your sexual behavior ever created problems for others?

Yes

No

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* 3. Do you ever hide any of your sexual behavior from others?

Yes

No

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* 4. Do you feel controlled by your sexual desire?

Yes

No

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* 5. I use sexual behavior or fantasy to escape.

Yes

No

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* 6. I was first exposed to pornography at age _____.

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

Not Applicable

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* 7. I have sought out pornography in the last _____. (Mark all that apply)

7 Days

4 Weeks

3 Months

6 Months

Year

Not Applicable

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* 8. When you have sex or act out sexually, do you feel sad afterwords?

Yes

No

Not Applicable

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* 9. When I am struggling with sexual behavior I do not like, I have pursued a friend or peer for help.

Yes

No

Not Applicable

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* 10. I believe my unwanted sexual behavior is the primary hinderance in my spiritual journey.

Yes

No

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* 11. If you would like some tools to help you achieve real freedom, please list your email and/or phone number.

Email:

Phone Number:

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* 12. If you listed your email and/or phone number above, please check the type of resources you would like to receive.

Male Resources

Female Resources

None