* 1. What is your gender?

* 2. How old are you??

* 3. How long have you been married?

* 4. Would you say you are a Christian/Follower of Jesus?

* 5. For this survey, porn use is defined as repeated, intentional, solo viewing of pornography.

Rate how hurtful/harmful/destructive each of the following is. Zero is not hurtful/harmful/destructive, 1 is just a bit, 7 is the worst.

  0 1 2 3 4 5 6 7
Committing adultery
Going to a strip club
Intentionally lusting after people in public
Looking at porn without masturbation
Looking at porn and masturbating
Hiding/lying about porn use

* 6. Do you think people can be addicted to porn?

* 7. Do you think you are addicted to porn?

* 8. Optional Comments

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