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1. What is your gender? (Required.)

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2. How old are you? (Required.)

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3. How long have you and your spouse been married? (Required.)

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4. How does the sexual frequency in your marriage (any form of sex with your spouse) compare to your ideal frequency? (Required.)

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5. How long have you and your spouse been married? (Required.)

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6. In an average week, how often do you and your spouse have some form of sex? (Required.)

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7. Optional Comments

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