* 1. Have you previously experienced nitrogen narcosis at any of the following depths? (mark all that apply)

* 2. What is your weight in kilograms? (if you have answered Yes to (1), give your weight when you last experienced narcosis)

* 3. What is your age? (if you have answered Yes to (1), give your age when you last experienced narcosis)

* 4. Are you male or female?

* 5. Have you ever experienced severe enough symptoms that you have been forced to ascend and complete a dive at a shallower depth?

* 6. Have you ever been forced to prematurely end a dive due to nitrogen narcosis?

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