ask-10-questions

Download questionnaire here [1]

10 SMART Questions

FOR THE BUSY DOCTOR

Short Questionnaire to be kept by Doctors of all Specialties in their waiting room.

QUESTIONNAIRE

Sexual Health Get it up. Get going.

Making Diagnosis and Treatment Fast and Easy

This is the shortest, quick and best questionnaire, which overcomes inhibitions in talking about sex with Doctor.

10 SMART Questions

AGE
GENDER

• *Male___
• *Female___
• *Other___

1. Early Discharge
2. Erection Problem
3. Size Penis
4. Cannot Insert
5. Weakness
6. Painful Sex
7. Less Desire
8. Partner Unsatisfied
9. Pregnancy Doubts
10. Other

Keep in Waiting Room
Doctors can keep this form in their waiting room so that patients seeking help in Sexual Health as well as the Doctors, can communicate avoiding overcoming 98% of shyness and inhibition to report and seek help for sexual dysfunctions. Note that name is purposely omitted to respect privacy of the individual.

[1]

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Download questionnaire_FOR THE BUSY DOCTOR