Placeholder Performance Assessment

Performance Assessment

My Age is

Over 31 Years
13-30 Years
Under 12 Years

I Exercise

Never/Once a week
Regularly/3-5 times a week

I have been feeling tired

Most Days
Not really

I indulge in

Smoking Regularly
Drinking Regularly/Caffeinated Beverages
Packaged Snacks & Sweets/Soft Drinks

My Stress levels are

Mostly High

I am prone to

Family History of Disorder(Maternal/Paternal)
Medical Conditions since Birth(Genetic/Autoimmune Disorders)
No Medical Conditions

My desire to have Sex is


Frequency of Sex is:

Once a Month/Its been a while since I have been Active
Twice a Month
Once a Week/More than once a Week

My Erection has

mostly been hard to maintain
sometimes been difficult to maintain
No issues

I Ejaculate

before penetration
too early during sex
with no issues
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