2020 Confidential Survey For Women Who are Married and/or in a Committed Relationship

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* 1. What is your age range?

I'm in my 30's

I'm in my 40's

I'm in my 50's

I'm in my 60's

I'm 70 or older

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* 2. How often do you have sex?

Every day or more

5 - 6 times a week

3 - 4 times a week

1 - 2 times a week

1 - 2 times a month

Less than once a month

Less than 10 times a year

Never

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* 3. Rate the quality of your orgasms from 0 - 5 where 0 = not at all/never and 5 = toe curling fireworks

0

3

5

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. Are you aware of the benefits that women gain from experiencing orgasms?

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* 5. Are you really satisfied with your sex life?

Yes

No

If no, how is that impacting your life?

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* 6. Would you be interested in improving the quality of orgasms?

Yes (If yes please contact 770-675-3609)

No

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* 7. Does your significant other struggle with Erectile Dysfunction (E.D.)?

Yes

No

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* 8. All the information obtained from this survey is completely anonymous and confidential. However, if you'd like to learn more about our treatments or have questions, we'd love to speak with you. Please call our office at (770) 675-3609 or provide your contact info below.