In-Person or Virtual - Real Results That Last

— FREE ONLINE TRAINING —

"Hope is a verb with its shirtsleeves rolled up."

Hi, I'm Shari James RN

GIVE YOURSELF 5 MINUTES TO FILL
THIS OUT

This form is HIPPA Compliant.
Your answers are 100% Confidential.

What's your name? *

Nice to Meet You. How's Your Day Going? *

Great

Meh

Grrr

What Is Your Best Email Address? *

Phone *

Sharing your number lets me notify you that your consult video is ready, and makes it easy for you to reach me. Your privacy is always respected.

Where are you located? *

What Is Your Age? *

What Is Your Relationship Status? *

Single and ready to mingle

Single and I have retreated from the dating scene

In a relationship

It's complicated

Think about WHY you reached out to me. Now state the "end result" of your sexual performance goal as if it has happened. *

What treatments or approaches have you tried in the past? *

For the upcoming questions, please refer to my FIRMNESS SCALE based on the numbers 1-10.

A 7 out of 10 on the scale indicates that penetration is possible but you are not necessarily rock hard.

Think back to the last several times you had sex. What number or range of numbers could you get to on a scale of 1-10. *

Where you taking any ED Pills? *

Yes

No

How many mornings a week do you wake up with a 7 or above morning erection? *

Do you experience SEXUAL PERFORMANCE ANXIETY? *

YES!

SOMEWHAT

NOT AT ALL

Do you want to MASTER EJACULATORY CONTROL and learn to create 3 different types of ORGASMS? *

Yes

No

On a scale of 1-10 how dedicated are you to healing or mastering this problem? *

Select the one that best describes you. *

I have the financial resources to invest in myself.

I have access to financial resources to invest in myself.

I don't have any financial resources, I will keep things exactly as they are.

Where did you find me? *

Examples: Social Media Platform/YouTube/Google Search/Podcast/Sacred Eros Referral. *Please be as specific as possible.

Click this box to join the Himology Newsletter.

Get enlightened on men's sexual health & performance plus relating to women. As a subscriber, you get exclusive offers and specials.