Information provided will remain strictly confidential and will help determine the best course of action for us to assist you.
1. Full Name:
5. Zip Code:
6. Phone Number:
7. Email Address:
8. How long have you lived at this location?
9. How many occupants at this location?
10. How many previous owners (if known)?
11. Age of Site (if known)?
12. How many rooms at the location?
13. Do you have any Pets?
14. History of Site? (if known) Tragedies, Death's, Previous complaints.
15. Has there been any recent remodeling? if so, what and where?
16. Has any Religious clergy been consulted?
17. Describe the first occurrence of the phenomena? where and what happened
18. What time was the first occurrence of the phenomena?
19. Who first witnessed the phenomena?
20. Were their any other witnesses during the first event?
21. Have three been any odors?
22. Have there been any problems with electrical appliances?
23. Have there been any problems with plumbing?
24. Have there been any voices?
25. Have there been any sounds?
26 Have there been any movement of objects? if so, when, where and what
27. Have there been any uncommon cold or hot spots? if so, when and where
28. Has there been any apparitions? if so, when, where and what (describe the apparition)
29. Have there been any physical contact? if so, who and when
30. Has there been any other witnesses besides the occupants? If so who?
31. Are pets affected? if so, how
32. How often does the phenomena occur?
33. How Long is the average duration of the phenomena?
34. Any occupants have nightmares or trouble sleeping? if so, who and when
35. what do you believe is happening?
36. Do all of the occupants agree on what is happening?
37. What would you like to see accomplished by our vist?
38. Do you feel the phenomena is threatening? if so, why
39. Additional Comments: