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Individual Psychological/Relational/Sexual History

Please complete the assessment below before scheduling an appointment

I want to hear all your strengths as well as vulnerabilities. I appreciate you being as forthcoming and honest as possible.

At the end, I’ll ask if there is anything sensitive or secret that you do not want shared with your partner. I will not share it without your permission.

However, I want to understand you and your experiences as much as possible so I can be the most helpful in resolving these problems.

Contact Information


Social and sexual experiences as a child

Puberty and adolescence

Present Relationship

Wrap-Up Questions