Sexual Health Evaluation Questionnaire Sexual Health Evaluation Questionnaire This questionnaire is an important part of the assessment you are doing with Dr. Simpson. These are deeply personal questions, but please be completely honest in your answers. You will have an opportunity to give further clarification when you meet with Dr. Simpson. Thank you. Name First Last Question 1(Required)Have you ever had sexual fantasies that would be illegal in real life (rape, voyeurism, exhibitionism, sex with a child, etc.)? No Yes Explain "Yes" on Question 1Question 2(Required)Have you ever fantasized about having sex with children? No Yes Explain "Yes" on Question 2Question 3(Required)Have you ever masturbated to pictures or videos of prepubescent children? (ages infant-to-12) No Yes Explain "Yes" on Question 3Question 4(Required)Have you ever had a collection of prepubescent child pornography? (ages infant-to-12) No Yes Explain "Yes" on Question 4Question 5(Required)Have you ever masturbated to pictures or videos of teens you knew were under the age of 18? No Yes Explain "Yes" on Question 5Question 6(Required)Have you ever had a collection of sexual pictures or videos of teens that you knew were under the age of 18? No Yes Explain "Yes" on Question 6Question 7(Required)Have you ever thought about children in a sexual way? No Yes Explain "Yes" on Question 7Question 8(Required)Have you ever exposed your genitals to non-consenting children, teens or adults? No Yes Explain "Yes" on Question 8Question 9(Required)Have you ever looked in windows or in bathroom stalls to see people undressing, urinating or defecating? No Yes Explain "Yes" on Question 9Additional Comments
