NextReference code (leave this empty)Page 1 of 7Page 1 of 7Each time you press Next or Previous, your answers so far are saved (encrypted) for this browser, for up to 24 hours after your last change. On a shared or public computer, finish the form or press “Start over” before you leave.Your NameDateYour Life and Sexual History Questionnaire This questionnaire will ask you quite a few questions. Some will be general, about your life and you as a person. Others will be directly related to the accusations against you. I’d like you to be as honest as possible in answering these questions. It allows me to complete the most accurate and most helpful assessment. Please don’t be embarrassed. After 30 years of sexual evaluations, I’ve heard anything you might have to share. Let’s start with some background information. Who are the important people in your life?How long have you known each of them?How often do you speak to them?When was the last time you spoke to them?What kind of support are they offering you now?In what ways do you think they will be able to offer you support in the future?What sorts of problems have they helped you with in the past?What sorts of problems have you helped them with?Have they ever been in trouble with the law?Do they use/abuse alcohol or drugs?Have they ever been accused of committing a sexual offence?Do they know about your charges/offences?How do they feel about the way you have been treated by the criminal justice system?How do they feel about sex offender treatment (if this applies)?How do they feel about conditions or restrictions associated with your arrest or sentence?Intimate Relationships:Have you ever been in a long-term intimate relationship?YesNoIf “yes”, describe your first long-term intimate relationship. At the end this section you can describe any current intimate relationship you are in. Their first nameDateDid you live together?YesNoWere you married?YesNoWhen did this relationship end:How did you feel emotionally with this partner?What did you have in common?What were some of the problems in the relationship?Was there any emotional, physical, or sexual abuse?Who ended the relationship? Why? (If they ended it, did you agree/understand their reasons?)Has family or friends ever intervened/interfered with this relationship?Have the police ever been called to the home?If you have been in additional long-term intimate relationships, please describe these hereNext
