thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
Remember the times of playing doctor? or did you miss that? PM today for a New Patient Packet
Doctor taking new patients
- Thread starter thickdick016
- Start date
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
Application
Sex Therapy Office Dr. K. Pinalikapus
Personal Info
Name: ________________________________ Age: ____________________
Reason for Visit: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
Height: ________ Weight: _________ Hair/Eye: _____________________
Bra Size: _________ Shoe Size:__________
Experience Questionare
When you have sexual thoughts, how strong is your desire to engage in sexual behavior with a partner?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
When you see an attractive person, how strong is your sexual desire?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
When you spend time with an attractive person (for example, at work or at school), how strong is your sexual desire?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
When you are in a romantic situation (such as a candle lit dinner, a walk on the beach, etc.), how strong is your sexual desire?
No desire/ Strong desire
1 2 3 4 5 6 7 8 9
How important is it for you to fulfill your sexual desire through activity with a partner?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
Compared to other people of your age and sex, how would you rate your desire to behave sexually with a partner?
Much less desire/Much more desire
1 2 3 4 5 6 7 8 9
How strong is your desire to engage in sexual behavior by yourself?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
How important is it for you to fulfill your desires to behave sexually by yourself?
No at all important/Extremely important
1 2 3 4 5 6 7 8 9
Compared to other people of your age and sex, how would you rate your desire to behave sexually by yourself?
Much less desire/Much more desire
1 2 3 4 5 6 7 8 9
How long could you go comfortably without having sexual activity of some kind?
Sex without love is okay? YES / NO
I am sexually attracted to men more than to women? YES / NO
I would have to be closely attached to someone (both emotionally and psychologically) before I could feel comfortable and fully enjoy having sex with him or her? YES / NO
I fantasize a lot about having sex with men/women? YES / NO
If I am in a setting where there are lots of attractive people, I spend more time looking at women than at men? YES / NO
Has a guy ever without your conceient touched you or discreetly groped you in a crowded place? YES / NO
I must be in love with someone before I can be physically intimate with that person? YES / NO
Would you rather : 1)Have sex with 18 year old 2)Have sex with 55 year old 3) Both
I am sexually attracted to women? YES / NO
I have at least once fantasized about having sex with different people? YES / NO
I think about sex every day? YES / NO
Sexual pleasure is the most intense pleasure a person can have? YES / NO
My conscience bothers me too much when it comes to sex? YES / NO
I think the female body is sexy to look at? YES / NO
Is there anyone on your top friends list you would have sex with? YES / NO
Have you ever taken your clothes off for money? YES / NO
Have you been caught having sex ? YES / NO
Have you ever flashed at someone? YES / NO
Have you ever...
Had an arousing dream? (Wet dreams and the like) YES / NO
Had an arousing dream that led to climax during sleep? YES / NO
Been sexually aroused? YES / NO
Verbally expressed obscenities? (uttered, yelled, muttered, etc.) YES / NO
Sexually fantasized about your long-term instructor, mentor, or someone who is superior to you? (One-day skydiving teachers, or two-hour ski instructors and the like do not count.) YES / NO
Sexually fantasized about your lawyer, doctor, nurse, psychiatrist or someone with whom you are having a professional relationship? YES / NO
Sexually fantasized about someone you know personally but not closely? YES / NO
Sexually fantasized about anyone and masturbated at the same time? YES / NO
Read pornographic periodicals? YES / NO
Bought pornographic materials? (Not had a friend buy it for you; you brought it up to the counter and paid the cash, or had it sent to your house.) YES / NO
Read sexually explicit literature? YES / NO
Gone skinny dipping alone? YES / NO
Made obscene phone calls? YES / NO
Phoned up any recorded phone sex numbers (this includes answering machines with "phone sex" material)? YES / NO
Had live phone sex? YES / NO
Masturbated to orgasm while on the phone, but while the other person was not aware of it? YES / NO
Had cybersex? YES / NO
Masturbated? YES / NO
Masturbated to orgasm? YES / NO
Masturbated to orgasm at least five times in one twenty-four hour period? YES / NO
Masturbated to orgasm on a fairly regular basis of no less than once a fortnight? YES / NO
Masturbated to orgasm where you could have been discovered? (In a crowd, in public, gym/dorm/barracks showers, movie theater, etc.) YES / NO
Masturbated to orgasm out in the wild or in nature with no nearby civilization? YES / NO
Masturbated to orgasm while reading either pornographic or sexually explicit materials? YES / NO
Masturbated to orgasm while driving a land vehicle? YES / NO
Masturbated to orgasm while in a bathroom of the opposite sex? YES / NO
Masturbated to orgasm while watching an R or X-rated show? YES / NO
Masturbated to straight pornography? YES / NO
Masturbated to gay pornography? YES / NO
Inserted your finger into your rectum? YES / NO
Performed oral sex on yourself? (Yes, this is possible.) YES / NO
Stuffed your bra ? YES / NO
Intentionally dressed in revealing clothes?YES / NO
Streaked, flashed, or otherwise partially or totally exposed yourself in public before (or after) an informal, unofficial gathering of people?YES / NO
...more than once? YES / NO
...more than ten times? YES / NO
Stripped naked for someone?YES / NO
Been paid to strip?YES / NO
Been in a circle jerk? YES / NO
Had sex in public? YES / NO
Been caught having sex in public?YES / NO
Played a game of strip poker?YES / NO
Received gifts of any sort in exchange for flashing your breasts, ass, or genitalia?YES / NO
Had sex with someone watching you but not participating? YES / NO
Intentionally listened in to other people performing sexual activities without their knowledge?YES / NO
Had sexual intercourse with more than 10 people (not necessarily at the same time)?YES / NO
Had sexual intercourse with more than 1 person in a 24 hour period?YES / NO
Had sexual intercourse with persons of both genders in a 24 hour period? YES / NO
Borrowed a room at a party to have sex or make out with someone? YES / NO
...more than once?YES / NO
...more than once at the same party? YES / NO
...more than once at the same party with two different people? YES / NO
Played a game which may require you or others to disrobe? YES / NO
Played a game which may require you or others to perform an action on another participant? YES / NO
Given a "sympathy fuck"? YES / NO
Initiated sexual activities with someone for the sake of those activities only?YES / NO
Willingly committed incest? YES / NO
Been involved in adultery? YES / NO
Had sex so strenuous that someone was injured in the course of it? YES / NO
Entered a bathroom of the opposite sex while you were not accompanied by someone of the opposite sex and were not involved in a search and/or rescue mission at the time? YES / NO
Received money or some favor in exchange for sexual activities?YES / NO
Had sex while either you or your partner, but not both, were under the age of consent for the state that you were in?YES / NO
Tasted your own orgasmic liquids? YES / NO
Had sexual intercourse with a religious officiary? (Priest, nun, mother-superior, cardinal, pope, etc.) YES / NO
Been involved in a double penetration, wherein two men have anal and vaginal sex simultaneously with a woman? YES / NO
Been involved in a threesome (a menage-a-trois)with two males and a female? YES / NO
...more than once? YES / NO
...more than five times? YES / NO
Been involved in a threesome with two females and a male?YES / NO
...more than once? YES / NO
...more than five times? YES / NO
Engaged in sexual activities with a person and his/her parent? YES / NO
Engaged in sexual activities, necking, or petting with a person and his/her sibling?YES / NO
Been involved in a gang bang, where several men (at least three) mount one woman?YES / NO
Participated in a heterosexual orgy or been involved in group sex? (Four people or more; partners must be exchanged.) YES / NO
Participated in a bisexual orgy or group sex? (Four people or more; partners must be exchanged.) YES / NO
Videotaped someone in a compromising position without their awareness (i.e., total
voyeurism)?YES / NO
Sex Therapy Office Dr. K. Pinalikapus
Personal Info
Name: ________________________________ Age: ____________________
Reason for Visit: _____________________________________________________
________________________________________________________________________
________________________________________________________________________
Height: ________ Weight: _________ Hair/Eye: _____________________
Bra Size: _________ Shoe Size:__________
Experience Questionare
When you have sexual thoughts, how strong is your desire to engage in sexual behavior with a partner?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
When you see an attractive person, how strong is your sexual desire?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
When you spend time with an attractive person (for example, at work or at school), how strong is your sexual desire?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
When you are in a romantic situation (such as a candle lit dinner, a walk on the beach, etc.), how strong is your sexual desire?
No desire/ Strong desire
1 2 3 4 5 6 7 8 9
How important is it for you to fulfill your sexual desire through activity with a partner?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
Compared to other people of your age and sex, how would you rate your desire to behave sexually with a partner?
Much less desire/Much more desire
1 2 3 4 5 6 7 8 9
How strong is your desire to engage in sexual behavior by yourself?
No desire/Strong desire
1 2 3 4 5 6 7 8 9
How important is it for you to fulfill your desires to behave sexually by yourself?
No at all important/Extremely important
1 2 3 4 5 6 7 8 9
Compared to other people of your age and sex, how would you rate your desire to behave sexually by yourself?
Much less desire/Much more desire
1 2 3 4 5 6 7 8 9
How long could you go comfortably without having sexual activity of some kind?
Sex without love is okay? YES / NO
I am sexually attracted to men more than to women? YES / NO
I would have to be closely attached to someone (both emotionally and psychologically) before I could feel comfortable and fully enjoy having sex with him or her? YES / NO
I fantasize a lot about having sex with men/women? YES / NO
If I am in a setting where there are lots of attractive people, I spend more time looking at women than at men? YES / NO
Has a guy ever without your conceient touched you or discreetly groped you in a crowded place? YES / NO
I must be in love with someone before I can be physically intimate with that person? YES / NO
Would you rather : 1)Have sex with 18 year old 2)Have sex with 55 year old 3) Both
I am sexually attracted to women? YES / NO
I have at least once fantasized about having sex with different people? YES / NO
I think about sex every day? YES / NO
Sexual pleasure is the most intense pleasure a person can have? YES / NO
My conscience bothers me too much when it comes to sex? YES / NO
I think the female body is sexy to look at? YES / NO
Is there anyone on your top friends list you would have sex with? YES / NO
Have you ever taken your clothes off for money? YES / NO
Have you been caught having sex ? YES / NO
Have you ever flashed at someone? YES / NO
Have you ever...
Had an arousing dream? (Wet dreams and the like) YES / NO
Had an arousing dream that led to climax during sleep? YES / NO
Been sexually aroused? YES / NO
Verbally expressed obscenities? (uttered, yelled, muttered, etc.) YES / NO
Sexually fantasized about your long-term instructor, mentor, or someone who is superior to you? (One-day skydiving teachers, or two-hour ski instructors and the like do not count.) YES / NO
Sexually fantasized about your lawyer, doctor, nurse, psychiatrist or someone with whom you are having a professional relationship? YES / NO
Sexually fantasized about someone you know personally but not closely? YES / NO
Sexually fantasized about anyone and masturbated at the same time? YES / NO
Read pornographic periodicals? YES / NO
Bought pornographic materials? (Not had a friend buy it for you; you brought it up to the counter and paid the cash, or had it sent to your house.) YES / NO
Read sexually explicit literature? YES / NO
Gone skinny dipping alone? YES / NO
Made obscene phone calls? YES / NO
Phoned up any recorded phone sex numbers (this includes answering machines with "phone sex" material)? YES / NO
Had live phone sex? YES / NO
Masturbated to orgasm while on the phone, but while the other person was not aware of it? YES / NO
Had cybersex? YES / NO
Masturbated? YES / NO
Masturbated to orgasm? YES / NO
Masturbated to orgasm at least five times in one twenty-four hour period? YES / NO
Masturbated to orgasm on a fairly regular basis of no less than once a fortnight? YES / NO
Masturbated to orgasm where you could have been discovered? (In a crowd, in public, gym/dorm/barracks showers, movie theater, etc.) YES / NO
Masturbated to orgasm out in the wild or in nature with no nearby civilization? YES / NO
Masturbated to orgasm while reading either pornographic or sexually explicit materials? YES / NO
Masturbated to orgasm while driving a land vehicle? YES / NO
Masturbated to orgasm while in a bathroom of the opposite sex? YES / NO
Masturbated to orgasm while watching an R or X-rated show? YES / NO
Masturbated to straight pornography? YES / NO
Masturbated to gay pornography? YES / NO
Inserted your finger into your rectum? YES / NO
Performed oral sex on yourself? (Yes, this is possible.) YES / NO
Stuffed your bra ? YES / NO
Intentionally dressed in revealing clothes?YES / NO
Streaked, flashed, or otherwise partially or totally exposed yourself in public before (or after) an informal, unofficial gathering of people?YES / NO
...more than once? YES / NO
...more than ten times? YES / NO
Stripped naked for someone?YES / NO
Been paid to strip?YES / NO
Been in a circle jerk? YES / NO
Had sex in public? YES / NO
Been caught having sex in public?YES / NO
Played a game of strip poker?YES / NO
Received gifts of any sort in exchange for flashing your breasts, ass, or genitalia?YES / NO
Had sex with someone watching you but not participating? YES / NO
Intentionally listened in to other people performing sexual activities without their knowledge?YES / NO
Had sexual intercourse with more than 10 people (not necessarily at the same time)?YES / NO
Had sexual intercourse with more than 1 person in a 24 hour period?YES / NO
Had sexual intercourse with persons of both genders in a 24 hour period? YES / NO
Borrowed a room at a party to have sex or make out with someone? YES / NO
...more than once?YES / NO
...more than once at the same party? YES / NO
...more than once at the same party with two different people? YES / NO
Played a game which may require you or others to disrobe? YES / NO
Played a game which may require you or others to perform an action on another participant? YES / NO
Given a "sympathy fuck"? YES / NO
Initiated sexual activities with someone for the sake of those activities only?YES / NO
Willingly committed incest? YES / NO
Been involved in adultery? YES / NO
Had sex so strenuous that someone was injured in the course of it? YES / NO
Entered a bathroom of the opposite sex while you were not accompanied by someone of the opposite sex and were not involved in a search and/or rescue mission at the time? YES / NO
Received money or some favor in exchange for sexual activities?YES / NO
Had sex while either you or your partner, but not both, were under the age of consent for the state that you were in?YES / NO
Tasted your own orgasmic liquids? YES / NO
Had sexual intercourse with a religious officiary? (Priest, nun, mother-superior, cardinal, pope, etc.) YES / NO
Been involved in a double penetration, wherein two men have anal and vaginal sex simultaneously with a woman? YES / NO
Been involved in a threesome (a menage-a-trois)with two males and a female? YES / NO
...more than once? YES / NO
...more than five times? YES / NO
Been involved in a threesome with two females and a male?YES / NO
...more than once? YES / NO
...more than five times? YES / NO
Engaged in sexual activities with a person and his/her parent? YES / NO
Engaged in sexual activities, necking, or petting with a person and his/her sibling?YES / NO
Been involved in a gang bang, where several men (at least three) mount one woman?YES / NO
Participated in a heterosexual orgy or been involved in group sex? (Four people or more; partners must be exchanged.) YES / NO
Participated in a bisexual orgy or group sex? (Four people or more; partners must be exchanged.) YES / NO
Videotaped someone in a compromising position without their awareness (i.e., total
voyeurism)?YES / NO
SwtSassyNrse26
Sweetly yours 💋
- Joined
- Apr 30, 2013
- Posts
- 4,697
Before I complete this I would like a copy of the HIPPA poicy please
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
bump!
bump!
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
Openings now available
Openings now available
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
Apply with PM
Apply with PM
cryingalien
Literotica Guru
- Joined
- Apr 30, 2005
- Posts
- 12,266
give the doc a consult please!
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
Pm for details
Pm for details
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
On now!
On now!
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
ok gotten a lot of interest in this through my inbox, anyone else?
ok gotten a lot of interest in this through my inbox, anyone else?
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
either fill out on forum or copy and paste to PM box
either fill out on forum or copy and paste to PM box
Goodgirljenny
Virgin
- Joined
- Oct 1, 2013
- Posts
- 8
Long interesting survey. I'm new and just browsing, but I just may fill it out for you today.
DevilInDetail
Detailed Roleplayer
- Joined
- Jun 11, 2013
- Posts
- 117
Now that survey must have taken some time to put together! Credit to your commitment and imagination!
AustinTrist
Really Experienced
- Joined
- Aug 28, 2013
- Posts
- 110
Before I complete this I would like a copy of the HIPPA poicy please
As someone familiar with the law, this made me laugh and remember my "Don't be a HIPPA-crit!" training class
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
Contact today, through PM
Contact today, through PM
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
Interested? Send PM
Interested? Send PM
txrunnerchick
Virgin
- Joined
- Jan 4, 2014
- Posts
- 10
Wow...I need a new patient consult, 1st available please...
achesonkatie
Virgin
- Joined
- Apr 15, 2013
- Posts
- 29
You've found my favorite game!
.....
.....
Last edited:
TicklishDaughtr
Virgin
- Joined
- Jan 5, 2014
- Posts
- 7
That application does look challenging. May be worth it to fill it out.
Okay, filled out and submitted. Now I'll probably have to wait six months for an appointment LOL
shewantsmore
Literotica Guru
- Joined
- Jul 2, 2006
- Posts
- 12,351
That would certainly take a while to think about answers and fill out
thickdick016
Really Experienced
- Joined
- Dec 16, 2010
- Posts
- 289
bump!
Still accepting patients
Still accepting patients
