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?

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