Sexual Health Survey
1.
To which gender identity do you most identify?
Female
Male
Transgender
Non-conforming
Other (please specify)
2.
What is your marital status?
Single
Married
Not married, but in a committed relationship
Separated
Divorced
Widowed
3.
How old are you?
18-29
30-44
45-59
60 or over
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
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
6.
Do you feel comfortable talking to your health provider about sex?
Yes
No
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.
Yes
No
8.
If yes, what is the best email address to reach you?
9.
How did you hear about this survey?
Current Progress,
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