770.649.0094
4343 Shallowford Rd #150, Marietta,GA 30062
VIRTUAL CONSULT
TEXT US
Home Page
About Dr. Kelley
Weight Loss
Weight Management program GLP1
Lean Body Program
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling for beautiful and healthy skin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
770.649.0094
4343 Shallowford Rd #150, Marietta,GA 30062
VIRTUAL CONSULT
TEXT US
Home Page
About Dr. Kelley
Weight Loss
Weight Management program GLP1
Lean Body Program
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling for beautiful and healthy skin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
Home Page
About Dr. Kelley
Weight Loss
Weight Management program GLP1
Lean Body Program
Wellness
Bioidentical Hormones
IV Therapy
Liquivida Drip Glossary
GI Health
Oshot l Feminine Rejuv
O Shot
Vampire winglift
V fit Gold
Procedures
Xeomin Wrinkle relaxer
Botox
Sculptra-CWA Precise Sculpt
Wrinkle Fillers- Contour and Rejuvenate
Radiesse-Contour, Lift and Tighten
Microneedling for beautiful and healthy skin
Exilis Elite Facial Skin Tightening
PRP Hair Therapy
Pre and Post PRP hair Instructions
PRP Injections
O Shot
Testimonials
Pricing
Sexual Function Questionnaire
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Sexual Function Questionnaire
General Information
Name:
Date
Sexual Function Questionnaire
How often do you feel distressed about your sex life?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel unhappy about your sexual relationship?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel guilty about your sexual difficulties?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel frustrated by your sexual problems?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel stressed about sex?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel inferior because of sexual problems?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel worried about sex?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel sexually inadequate?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel regrets about your sexality?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel embarrassed about your sexual problems?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel angry about your sex life?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel dissatisfied with your sex life?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
How often do you feel bothered by low desire?
0 Never
1 Rarely
2 Occasionally
3 Frequently
4 Always
Do you affirm that you have answered all questions truthfully and to the best of your knowledge?
*
Yes
