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How long have you been struggling with porn?
Less than 5 years
6–10 years
10-20 years
20+ years
How often do you watch porn per week on average?
About once a day (7+ times/week)
3–5 times/week
1–2 times/week
1–2 times/month
What have you already tried to quit porn?
Going cold turkey / relying on willpower
Accountability or telling someone
Content blockers / deleting apps
Prayer or spiritual practices
Therapy or counseling
Recovery groups/programs
Coaching
I haven't seriously tried anything yet
What’s the longest you’ve gone without porn in the last 12 months?
Less than 7 days
7–30 days
30–90 days
90+ days
Do you have a plan for how to overcome urges when they hit?
Yes, and it works most of the time
I have a plan, but it rarely works
No, I don’t really have a plan
How many people know about your struggle with porn?
No one
1 person
2–4 people
I’m open about it with several people
Are you currently in a relationship?
Single
Dating / In a relationship
Married
How up to date is your partner on your current struggle with porn?
They don’t know about it
I’ve told them in the past, but they don’t know it’s currently an issue
They’re fully up to date
Have you experienced challenges with arousal, intimacy, or sexual performance?
I’m single and choosing not to be sexually active before marriage
I feel like it’s affecting my sex drive / libido
I sometimes struggle with ED (erectile dysfunction)
No issues that I’ve noticed
What areas of your life has porn negatively affected?
Self-confidence
Relationships with friends or family
My marriage / romantic relationship
My relationship with God / spirituality
Mental health
Dating
Motivation / productivity
None of these
If nothing changes, what are you most afraid could happen in the next 3 years?
Losing or damaging an important relationship / future family
Escalating to more explicit content/actions
Staying stuck and not progressing in life
Continuing to lose confidence in myself
Other
How old are you?
Under 18
18–23
24–35
Over 35
What best describes what you're doing right now?
I’m working
I’m in school
I’m working and in school
I’m figuring things out right now
On a scale of 1–10, how serious are you about changing this in the next 90 days?
1 = Just exploring
10 = I’m fully committed
At this point, what feels like the right next step for you?
I’ve tried enough on my own — I’m ready to get help
I’m serious about changing, but want to try the right tools on my own
I know I need to change, but I’m not fully committed yet
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