Performance Anxiety

Do you get nervous in certain situations?

Please describe what symptoms you experience leading up to these situations?

Does this happen during sexual encounters?

Do you feel getting nervous/anxious is part of your life?

Do you feel performance anxiety impairs your full potential?

If you have tried a previous treatment, what was that treatment, was it successful, and are you still using it?

Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?

Do you have a preferred treatment?

Would you like to share anything else with your provider through an upload?

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Cancel Visit

Do you want to cancel the visit?