* Age - (1-10, 11-15, 16-20, 21-25, 26-30, 31-35, 36-45, 46-55, 56-65, other... specify if possible)
* What is/are your profession(s)? If you are a student, indicate so.
* How long have you been here? Be as precise as possible.
* Where are you from? (If you'd rather not give a city, a state or country will work fine.)
* What were you doing just before waking up here? (Again, be as specific as possible. If it's an uncomfortable matter, a general description can work)
* Where were you just before waking up here? (Be general, ie "out of the house" "at work" "en route somewhere" etc.)
* Your last memory: What time of day was it?
Optional - Anything else of note you may want to mention about the time before waking up here. Something out of the ordinary or significant? Or something new that may have started a little before moving here?
Feel free to ask if something concerns you.
[added in as though in after thought] Ah. Also, since safety is a heavy factor, I will be taking and collecting the responses as the data is sorted. Your information will not remain here. Please don't let that keep you from participating.