This is a general questionnaire designed to be applicable to as many people as possible. Some aspects of the questionnaire may not apply to your specific situation, so please ignore the section(s) not applicable to you. There is a section at the end of the questionnaire where you may provide us with additional information relating to your particular circumstances if you choose. You may complete this form by hand and mail or fax it to our office. You may also complete the form online and submit it to us via email.