Survey On Pornography

1.  Do you attend an Apostolic or Pentecostal Church?*

         Yes   No

2.  What is your current age?*

13-15   16-19   20-25   26-35   36-45   46-55   56-65   Over 65

3.  a.  Are you a licensed minister?*

Yes No

    b.  If no, do you feel a call to the ministry?

         Yes No
 
4.  a.  Have you been baptized in Jesus Name according to Acts 2:38?*

Yes No

    b.  Have you received the Holy Ghost with the evidence of speaking in other tongues according to Acts 2:4?*

Yes No

5.  Have you ever been tempted to view pornography?*  (If no, skip to question 16.)

Yes No

6.  At what age did you first see pornography?

Under 10   10-13   14-16   17-19   20-22   23-25   26-30  
31-35   36-40   41-45   46-50   51-55   56-60   Over 60   Never

7.  a.  Are you currently addicted to, bound by, or have an uncontrollable desire to view pornography?

Yes No

    b.  If yes, how do you currently access it? Check all that apply.

Magazines  
Books  
Video  
Internet  
Cable TV
Other

8.  If you had an addiction to pornography, but you have been delivered, how did you access or see it? Check all that apply.

Magazines  
Books  
Video  
Internet  
Cable TV
Other

9.  How frequently do you or did you use pornography? 
         
          Less than once a month   Once a month   2-3 times a month   Weekly   2-4 times a week 
          Daily   Other

10.  a.  Do you use a filter on your computer?

Yes No

     b.  If yes, have you ever shut it off in order to access pornography?

Yes No

11.  How long did you struggle, or have you struggled with your addiction to pornography?

Under one year   1-3 years   3-5 years   5-7 years   7-10 years   Over 10 years

12.  If you are currently addicted or bound by pornography, do you truly want deliverance from it?

Yes No

13.  Have you ever felt hopeless in trying to overcome the addiction or bondage?

Yes No

14.  a.  At any time, did you ever seek assistance for your problem?

Yes No

     b.  If yes, from whom? Check all that apply.

Pastor  
Minister  
Father  
Friend  
Medical Doctor  
Books
Internet  
Professional Counselor  
Other

15.  a.  If you are married, have you ever discussed your problem with your wife?

Yes No

     b.  If no, why not?  (Check all that apply)

Fear of rejection  
Fear of divorce
Your wife would not understand
Fear of losing everything
Other

16.  On a scale of 1 to 10, with 1 being very acceptable and 10 being repulsive, what do you think your wife's or future wife's impression of pornography is?*

Very acceptable 1 2 3 4 5 6 7 8 9 10  Repulsive

17.  Have you ever physically committed adultery? (For the purposes of this study, Matthew 5:28 does not apply.)*

Yes No

18.  At what age did you have your first sexual encounter with another individual?*

Under 10   10-12   13-15   16-18   19-21   22-25   26-30   31-35
36-40   Over 40   Never

19.  a.  What is your current marriage status?*

Single
Married
Divorced
Widower

     b.  If you have been or are currently married, were you a virgin when you first got married? (For the purposes of this study, any
          premarital sexual activity should be included.)

Yes No

 

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please do not do so here.  An email address is provided on the next page that is available for questions. 

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