THIS FORM IS COMPLETELY CONFIDENTIAL. Please complete every part it to the best of your ability, and be 100% truthful in every response. The sooner you complete this form, the better your memory will be about the incident and all the important facts. Your detailed answers to these questions will be our primary source of information about your case. (Fields marked with a * are required fields. You must answer them.) Not all questions will apply to you. There may be some information that you do not have. However, lack of information greatly impedes your case. The questions we ask may seem repetitive, detailed, or unimportant to your case. They are not. We will regularly refer to your answers to assist us in all phases of your case. All answers will be kept confidential. Please take sufficient time to complete this questionnaire. However, don't delay in returning the questionnaire since time can be an important factor in your case. When advancing from question to question, please use the <Tab> key. If you hit the <Enter> key, it may submit the questionnaire to us unfinished.