FrankTalk Therapy - Penuma Screening

Penuma Implant with Dr. Kambiz Tajkarimi

Welcome!
In order to help you in your decision to pursue the Penuma implant, Dr. Tajkarimi asks all patients to speak to a mental health professional. We want to do our best to assure you are supported along this journey.

To begin, please fill out the Patient information forms and the two questionnaires below. Then you may schedule an appointment with Paul Nelson, LMHC for a virtual meeting.

The fee for this appointment is $200.

STEP ONE - Complete Questionnaire 1

Please take a moment to complete Questionnaire 1 below.

Choose the repsonse that is closest to how you have been feeling in the past week. Don't take too long over your replies. Your immediate repsonses is best.

I feel tense or 'wound up':

Most of the time
A lot of the time
From time to time, occasionally
Not at all

I still enjoy the things I used to enjoy:

Definitely as much
Not quite so much
Only a little
Hardly at all

I get a sort of frightened feeling as if something awful is about to happen:

Very definitely and quite badly
Yes, but not too badly
A little, but it doesn't worry me
Not at all

I can laugh and see the funny side of things:

As much as I always could
Not quite so much now
Definitely not so much now
Not at all

Worrying thoughts go through my mind:

A great deal of the time
A lot of the time
From time to time, but not too often
Only occasionally

I feel cheerful:

Not at all
Not often
Sometimes
Most of the time

I can sit at ease and feel relaxed:

Definitely
Usually
Not Often
Not at all

I feel as if I am slowed down:

Nearly all the time
Very often
Sometimes
Not at all

I get a sort of frightened feeling like 'butterflies' in the stomach:

Not at all
Occasionally
Quite Often
Very Often

I have lost interest in my appearance:

Definitely
I don't take as much care as I should
I may not take quite as much care
I take just as much care as ever

I feel restless as I have to be on the move:

Very much indeed
Quite a lot
Not very much
Not at all

I look forward with enjoyment to things:

As much as I ever did
Rather less than I used to
Definitely less than I used to
Hardly at all

I get sudden feelings of panic:

Very often indeed
Quite often
Not very often
Not at all

I can enjoy a good book or radio or TV program:

Often
Sometimes
Not often
Very seldom

I am not a robot

STEP TWO - Complete Questionnaire 2

This questionnaire is about the way you feel about the size or appearance of your penis. Please read the questions carefully and circle the number which best describes the way that you feel about your penis. Please read the labels carefully to ensure you are circling the number that reflects how you feel, as some of the answers are worded in reverse order. Please answer how you have felt over the past week.

Date of Birth:

1) To what extent do you feel the size or appearance of your penis is defective or unattractive?

Very Much
Moderately
Slightly
Not at all

2) To what extent does the size or appearance of your penis currently cause you distress?

Not at all
Slightly
Moderately
Significant
Extremely

3) How often does the size or appearance of your penis currently lead you to avoid situations or activities?

Always Avoid
75% of the time
50% of the time
25% of the time
Never

4) To what extent does thinking about the size or appearance of your penis currently preoccupy you?

Not at all
Slightly
Moderately
Very
Extremely

5) If you have a regular partner, to what extent do your concerns about the size or appearance of your penis currently have an effect on an existing sexual relationship?

Not at all
Slightly
Moderately
Markedly
Extremely

6) How much do your concerns about the size or appearance of your penis currently interfere with your ability to work or study?

Not at all
Slightly
Moderately
Markedly
Extremely

7) To what extent do your concerns about the size or appearance of your penis currently interfere with your social life?

Not at all
Slightly
Moderately
Markedly
Very severely

8) To what extent do your concerns about the size or appearance of your penis currently interfere with leisure activities?

Not at all
Slightly
Moderately
Markedly
Very severely

9) How much do you feel the size or appearance of your penis is the most important aspect of who you are?

Not at all
Slightly
Moderately
Mostly
Totally

I am not a robot

STEP THREE - Schedule Your Appointment

instructions for booking online appointment

Penuma Implant with Dr. Kambiz Tajkarimi

STEP ONE - Complete Questionnaire 1

STEP TWO - Complete Questionnaire 2

STEP THREE - Schedule Your Appointment

STEP FOUR - Pay for Appointment

Start your Appointment

Do You Still
Have Questions?

Explore

Contact

Email Newsletter

Penuma Implant with Dr. Kambiz Tajkarimi

STEP ONE - Complete Questionnaire 1

STEP TWO - Complete Questionnaire 2

STEP THREE - Schedule Your Appointment

STEP FOUR - Pay for Appointment

Start your Appointment

Do You Still Have Questions?

Do You Still
Have Questions?