Sexual Health Survey

Question Title

1. To which gender identity do you most identify?

Female

Male

Transgender

Non-conforming

Other (please specify)

Question Title

2. What is your marital status?

Single

Married

Not married, but in a committed relationship

Separated

Divorced

Widowed

Question Title

3. How old are you?

18-29

30-44

45-59

60 or over

Question Title

4. What is your household income?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $149,999

Between $150,000 and $249,999

Over $250,000

Question Title

5. Which of these topics would you like to learn more about? (Please pick 2 maximum)

Tackling struggles around orgasm

How to maintain sexual desire in a long term relationship

Navigating mismatched libido with your partner

Sex toys and sex tech

Sex and casual relationships

Alternative relationships (e.g: swinging, polyamory, non consensual monogamy, etc)

Kink and/or BDSM

Question Title

6. Do you feel comfortable talking to your health provider about sex?

Yes

Question Title

7. If selected, would you be open to talking about your area of interest over the phone/Zoom for less than 10 minutes? As a token of our appreciation we would be happy to send you a $20 gift card.

Sexual Health Survey

Question Title

1. To which gender identity do you most identify?

Question Title

2. What is your marital status?

Question Title

3. How old are you?

Question Title

4. What is your household income?

Question Title

5. Which of these topics would you like to learn more about? (Please pick 2 maximum)

Question Title

6. Do you feel comfortable talking to your health provider about sex?

Question Title

7. If selected, would you be open to talking about your area of interest over the phone/Zoom for less than 10 minutes? As a token of our appreciation we would be happy to send you a $20 gift card.

Question Title

8. If yes, what is the best email address to reach you?

Question Title

9. How did you hear about this survey?

Sexual Health Survey

Question Title

* 1. To which gender identity do you most identify?

Question Title

* 2. What is your marital status?

Question Title

* 3. How old are you?

Question Title

* 4. What is your household income?

Question Title

* 5. Which of these topics would you like to learn more about? (Please pick 2 maximum)

Question Title

* 6. Do you feel comfortable talking to your health provider about sex?

Question Title

* 7. If selected, would you be open to talking about your area of interest over the phone/Zoom for less than 10 minutes? As a token of our appreciation we would be happy to send you a $20 gift card.

Question Title

* 8. ﻿If yes, what is the best email address to reach you?

Question Title

* 9. How did you hear about this survey?

1. To which gender identity do you most identify?

2. What is your marital status?

3. How old are you?

4. What is your household income?

5. Which of these topics would you like to learn more about? (Please pick 2 maximum)

6. Do you feel comfortable talking to your health provider about sex?

7. If selected, would you be open to talking about your area of interest over the phone/Zoom for less than 10 minutes? As a token of our appreciation we would be happy to send you a $20 gift card.

8. If yes, what is the best email address to reach you?

9. How did you hear about this survey?