Please indicate gender:
Male
Female

Indicate Orentation:
Heterosexual
Bisexual
Homosexual

Please answer “yes” to any of the following which apply:

I have no concerns about my sexual behavior but am curious how I would score.
Yes
No

I have no concerns about my sexual behavior but others are concerned.
Yes
No

I am having problems with my sexual behavior but do not consider myself a “sex addict”.
Yes
No

I know I am a sex addict.
Yes
No

I have sought therapy because of my sexual problems.
Yes
No

Were you sexually abused as a child or adolescent?
Yes
No

Did your parents have trouble with sexual behavior?
Yes
No

Do you often find yourself preoccupied with sexual thoughts?
Yes
No

Do you feel that your sexual behavior is not normal?
Yes
No

Do you ever feel bad about your sexual behavior?
Yes
No

Has your sexual behavior ever created problems for you and your family?
Yes
No

Have you ever sought help for sexual behavior you did not like?
Yes
No

Has anyone been hurt emotionally because of your sexual behavior?
Yes
No

Are any of your sexual activities against the law?
Yes
No

Have you made . efforts to quit a type of sexual activity and failed?
Yes
No

Do you hide some of your sexual behaviors from others?
Yes
No

Have you attempted to stop some part of your sexual activity?
Yes
No

Have you felt degraded by your sexual behaviors?
Yes
No

When you have sex, do you feel depressed afterwards?
Yes
No

Do you feel controlled by your sexual desire?
Yes
No

Have important parts of your life (such as job, family, friends, leisure activities) been neglected because you were spending too much time on sex?
Yes
No

Do you ever think your sexual desire is stronger than you are?
Yes
No

Is sex almost all you think about?
Yes
No

Has sex (or romantic fantasies) been a way for you to escape your problems?
Yes
No

Has sex become the most important thing in your life?
Yes
No

Are you in crisis over sexual matters?
Yes
No

Has the Internet created sexual problems for you?
Yes
No

Do you spend too much time online for sexual purposes?
Yes
No

Have you purchased services online for erotic purposes (sites for dating, pornography, fantasy and friend finder)?
Yes
No

Have you used the Internet to make romantic or erotic connections with people online?
Yes
No

Have you attempted to stop online sexual behavior?
Yes
No

Have you subscribed to or regularly purchased or rented sexually explicit materials (magazines, videos, books or online pornography)?
Yes
No

Have you been sexual with minors?
Yes
No

Have you spent considerable time and money on strip clubs, adult bookstores and movie houses?
Yes
No

Have you engaged prostitutes and escorts to satisfy your sexual needs?
Yes
No

Have you spent considerable time surfing pornography online?
Yes
No

Have you used magazines, videos or online pornography even when there was considerable risk of being caught by family members who would be upset by your behavior?
Yes
No

Have you regularly purchased romantic novels or sexually explicit magazines?
Yes
No

Have stayed in romantic relationships after they became emotionally or physically abusive?
Yes
No

Have you traded sex for money or gifts?
Yes
No

Have you maintained multiple romantic or sexual relationships at the same time?
Yes
No

After sexually acting out, do you sometimes refrain from all sex for a significant period?
Yes
No

Have you regularly engaged in sadomasochistic behavior?
Yes
No

Do you visit sexual bath-houses, sex clubs or adult video/bookstores as part of your regularly sexual activity?
Yes
No

Have you engaged in unsafe or “risky” sex even though you knew it could cause harm?
Yes
No

Have you cruised public restrooms, rest areas or parks looking for sex with strangers?
Yes
No

Do you believe casual or anonymous sex has kept you from having more long-term intimate relationships?
Yes
No

Has your sexual behavior put you at risk for arrest for lewd conduct or public indecency?
Yes
No

Have you been paid for sex?
Yes
No