1. Do you have any addictions such as watching pornography, drugs, alcohol, or gambling?
B. Not anymore/I am not sure
2. Do you have family members with any addictions?
B. I don’t know/I think so
3. How often do you watch pornography?
A. A few times a month
B. A few times a week
C. Every day
4. Have your sexual thoughts and/or behaviors ever caused issues in any of your relationships with family, friends or your significant other?
5. Have you ever paid for sex?
B. Only a few occasions
C. Yes, numerous times
6. Have you ever been arrested for any sexual offenses?
A. Of course, no!
B. No. I have a high sex drive, but I haven’t done any offense!
C. Yes / No, I narrowly escaped!
7. Are you distressed by your sexual behavior that causes you to have negative feelings about yourself?
C. Yes, all the time
8. Can you control your sexual impulses, thoughts, or desires?
C. No, most of the time I can’t
9. Do you try to hide your sexual behaviors, thoughts or desires from others
B. Most of the time I do not
C. Yes I do
10. How often do you think about sex?
A. A few times a week
C. All day every day