Questions for a Victim of Sexual Assualt

Truth That Hurts......

1. Someone fondled you (i.e., touched your genitals or other parts of your body) in a sexual way. YES____ NO____If yes...
             Who was the person?___________________
             Was the person male or female?__________
             How old were you at the time?____________
             About how old was the other person?______
             How many times did it happen?___________
             For how long did it happen (i.e., days,
             weeks, months, years)?_________________
             How do you now feel about the experience
             (i.e., negative, neutral or positive)_________
             How distressing did you find this at the time:
             Not at all distressing - A . . . . . B . . . . . C . . . . . D . . . . . E - Very distressing
             How much force or persuasion did the person use?
             (Please check off the appropriate categories below.)
             Activity was voluntary____
             They took advantage of your trust____
             They used bribes or enticements____
             They used sexual seduction____
             They used intimidation or adult authority____
             They used threats against you or someone else____
             They used physical force____
             Other (please explain)_______________________
   
2. A woman had you perform vaginal intercourse on her. YES____ NO____If yes...
             Who was the person?___________________
             . . . . [see above]