Male Questionnaire Form. Please click here for Female Form. Tick the box on the last page of the questionnaire if you would like a copy emailed to you. All information is confidential and used solely for the purpose of helping you solve your problems when you book a session. Please provide me with accurate and detailed information for the questions below:
Describe your biggest issues and what concerns you most:
In what ways do these issues affect you?
How long have you had these issues?
What previous treatments have you tried and what success did you have?
Other health issues:
Do you take medications for these other health issues? If so, which issues:
Give details of sexual frequency here:
Do you still have morning erections (or random erections throughout the day)?
Approximately what size/length is your penis when fully erect?
How long has it been since you last had sex?
What currently happens for you during sex?
Are you more prone to losing your erection or losing control during sexual activity?
How long do you last during intercourse?
What are you aware of thinking and feeling during intercourse?
How long do you last during oral?
What are you aware of thinking and feeling during oral?
Do you get hard when you masturbate?
How long do you usually last when you masturbate?
What are you aware of thinking and feeling when you masturbate?
How long have you been together?
Do you ever have casual sex (outside of your relationship)?
Does your partner know you are here?
Do you intend to tell your partner?
How many children do you have?
What age/s are your children?
Do your children live with you?
Is home a relaxing environment for you?
If not, why?
How long has it been since your partner initiated sex?
Is your partner able to orgasm during intercourse?
Describe what you think influences your partner's choice of sexual frequency:
What are your thoughts about sexual fantasies?
How much does your partner participate in sexual fantasies?
What level of sexual fantasy must you have to feel sexually fulfilled? ie: threesome, partner in lingerie, etc:
What is your minimum involvement in sexual activity with a partner, required for you to feel sexually fulfilled? ie:
cocked sucked daily / sex twice weekly / ??
Describe your ideal sex life including frequency:
How much do you love your partner?
Is your relationship worth saving?
What happens for you on a sexual level?
When do you lose erection hardness?
When do you lose control over ejaculation?
If you often feel sexually frustrated, is this because of your sexual problem or?
How much does your partner participate to ensure you are sexually fulfilled?
How have you addressed the issues in the previous question?
Anything else with regards to your partner's sexual participation?
What support do you give your partner to eliminate potential problems?
The personal attraction factor (please indicate all that apply)
How would you describe your current level of health and fitness?
How do you feel on a personal level?
What foods do you snack on?
Which hot and cold beverages do you consume throughout the day?
What food combinations do you usually have for breakfast?
What food combinations do you usually have for lunch?
What food combinations do you usually have for evening meals?
How frequently do you exercise?
What do you currently do for exercise?
How do you fulfill yourself in your spare time? (What do you do for hobbies?)
What else has come to mind that you want clarity on?
Please supply any other relevant or in-depth details here:
Send me a copy