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Question Form

All questions must be answered, but if you don't know the answer you can put N/A for your answer.* 1.Address of site: *2. Name of witness:
*3. Mailing address if different:
*4. Phone number: *5. Email Address: *6. How many occupants at location: *7. How many pets: *8. Occupants' names and ages: *9. Occupants' occupations:
*10. Occupants' religious beliefs *11. Time of occupancy at the location: *12. Age of the site: *13. How many previous owners (if known): *14. History of site: (tragedies, deaths, previous complaints)
*15. How many rooms in the site: *16. Has the location been blessed:
Yes
No
Unknown
*17. Has there been any recent remodeling (if so, what and where):
*18. Any occupants on prescribed medication (anxiety, depression, pain, etc) Please list names and medications:
*19. Any occupants using illegal drugs (this will be kept confidential):
*20. Any occupants drink alcohol heavily (this will be kept confidential):
*21. Any occupants interested in the occult: (Ouija, séances, psychics, spells) If so, who and what?
*22. Any occupants currently seeing a psychiatrist or in therapy (this will be kept confidential): if so, who
*23. Any occupants with frequent or unexplained illnesses (if yes, describe):
*24. Have any religious clergy been consulted: If so, please list church:
*25. Has there been any media involvement: If so, who:
*26. Have there been any other witnesses besides the occupants (names and relationships)
*27. Have there been any odors: (i.e. perfumes, flowers, sulfur, ammonia, excrement, etc) If so, when, where and what:
*28. Have there been any sounds: (i.e. footsteps, knocks, banging, etc) If so, when, where and what:
*29. Have there been any voices: (whispering, yelling, crying, speaking) If so, when, where and what
*30. Has there been any movement of objects, If so, when, where and what:
*31. Has there been any apparitions, If so, when, where and what (describe the apparition):
*32. Have there been any uncommon cold or hot spots: If so, when, where and what:
*33. Have there been any problems with electrical appliances: (TV, lights, kitchen appliances, doorbells) If so, when, where and what:
*34. Have there been any problems with plumbing: (leaks, flooding, sinks, toilet bowls) If so, when, where and what:
*35. Any occupants having nightmares or trouble sleeping: If so, who and when:
*36. Have there been any physical contact: If so, who, where and what happened:
*37. Are pets affected: If so, how:
*38. Describe the first occurrence of the phenomena: (what and when happened?)
39. Who first witnessed the phenomena:
*40. What time was the first occurrence of the phenomena: *41. What is the witness's reaction during the phenomena: *42. Were there any other witnesses during the first event:
Yes
No
Unknown
*43. How long is the average duration of the phenomena: *44. How often does the phenomena occur: *45. Do any of the occupants feel the phenomena is threatening: If so, who and why?
*46. What do the occupants believe is happening: (i.e. it's supernatural, natural, unsure, etc.) :
47. Do all of the occupants agree on what is happening, Do any think it's nonsense or not happening:
Yes Agree
Some Agree
Some think it's nonsense
Some think it's nothing

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