Runs entirely on your device. This assessment does not send, upload, sync, or store your answers anywhere - there is no server, no account, and no tracking. Your responses live only in this browser tab and disappear when you close or reload it. Use Export any time to save a copy for yourself, or to bring with you to a session.
Nature of this resource. This worksheet is a psychoeducational resource created by Garden Space Counseling PLLC. It is intended for use as a supplement to professional mental health treatment and is not a substitute for therapy, clinical assessment, or the guidance of a licensed mental health professional.
No therapeutic relationship. Downloading or completing this worksheet does not establish a therapeutic relationship between you and Garden Space Counseling PLLC or any of its clinicians. It does not constitute professional advice, a clinical recommendation, or a treatment plan.
General educational material. This resource is provided as general educational material. It has not been empirically tested as a clinical instrument. The content reflects current clinical frameworks and research literature but does not account for the specific circumstances, history, or needs of any individual or couple.
Emotional content. Reflection and self-assessment can be emotionally activating. If completing this worksheet brings up significant distress, trauma symptoms, or thoughts of harming yourself or others, please stop and contact a licensed mental health professional or call/text 988.
No warranty. Garden Space Counseling PLLC makes no warranties, express or implied, regarding the outcomes of using this material. Use of this worksheet is entirely voluntary and at the user's own discretion.
Licensure and jurisdiction. This resource is provided by a licensed professional counselor in Texas. It is not intended to establish a clinical relationship or constitute professional services in any jurisdiction.
© Garden Space Counseling PLLC. This worksheet may be downloaded and used for personal use. It may not be reproduced, redistributed, sold, or presented as one's own work without written permission.
Important: If you are in crisis, feel unsafe, or are experiencing thoughts of harming yourself or others, please reach out to a mental health professional or call/text 988 before completing this assessment.
This assessment will help us map your experiences of sex and intimacy - including what feels supportive, what feels challenging, and what you may want to change. It looks at sexual health, emotional safety, expectations, connection, and meaning, rather than performance, frequency, or intensity.
Please answer based on your lived experience, not what you think should be true, and know that you are in control of what you share. You may skip any question, answer generally, or return to topics later. The goal is not to push toward any particular outcome, but to give us a shared language and starting point so we can work together in a way that feels safe, respectful, and aligned with your values and current capacity.
How to answer
Most items use a 1–5 scale, where 1 = Never and 5 = Always. A few items ask for Yes / No / Unsure, and the last section invites a few open reflections in your own words. Nothing is required - leave anything blank that doesn't feel ready to answer yet.
A few closing reflections, in your own words.
Nothing here has been sent anywhere. Export a copy below, or bring this screen into a session to talk through together.