How did you first come into contact with the group, leader and/or counselor?
Where & when did first contact with the group, leader and/or counselor occur?
What type of abuse, exploitation and/or personal injury did you suffer through your involvement with the group, leader and/or professional person in question? Describe this in some detail.
Approximately how long and/or how many times, did you suffer such abuse?
Did anyone else also experience personally injuries through abuse and/or exploitation that you can recall within or through the group, leader and/or professional person in question?
Has there been related physical and/or mental/emotional problems as a related result of this abuse? Explain.
Have you ever been ill within the group? Did you receive proper medical and/or other professional attention? Who paid for this treatment?
What money, material goods, property, etc. have you given to the group, leader and/or professional that is involved?
Were other members of your family, close friends or professional/business associates somehow also involved with the group, leader and/or professional person in question?
What specifically convinced you that the group, leader and/or professional person is destructive/harmful or negative?
Are you now in contact with other professionals concerning this situation? Please name any professionals or persons you have contacted.
Please include any additional information you feel might be helpful or in some way meaningful.