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Get Sexual Assault History Form / 2017 A. Survivor Information B ...

Time of prior sexual assault is unknown, check: Age Unknown (skip to q.15) 14a. If the survivor experienced a prior sexual assault/abuse at any time before age 18, did the survivor ever become pregnant before age 18? Yes (answer q.14b) No Unknown 14b. If Yes, was the pregnancy a result of the prior sexual assault? Yes No Unknow.

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