4) Men's Health History Name Are you sexually active? --- No Yes If Yes, do you use condoms? --- No Yes n/a How would you rate your libido? --- Poor Fair Good Great Do you have more than one sexual partner? --- No Yes Have you ever been tested for HIV and/or AIDS? Have you ever had any Sexually Transmitted Diseases? --- No Yes If Yes, please specify How often do you get screened for STD's? Have you had a prostate exam? --- No Yes If Yes, when? Enter Code Powered by ChronoForms - ChronoEngine.com
