Assuming that we are gathering details like browser name, browser version, page URL, error message, etc behind the scenes in hidden fields.
Users hate more input requested off them. Its best if we limit the entry needed from the user and make it as simple as possible. As you already are gathering most important information necessary to troubleshoot the issue (like browser, error etc) in the background, users dont have to know all that. Just give them one simple box to enter any additional information and a send button. Unless there is a strong reason to break it down into multiple fields, or there is a strong reason for you to believe that users have the motivation to take time to answer your multiple questions, dont do this. This should be enough...
Agreeing with PK2016, keep it simple. But consider prompting your users for the information that you're looking for. Rather than "Any additional details about the issue", consider asking for
"Details (what you were doing, what happened, what you expected to happen, color of your socks, etc)"