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:
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. Have 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. Has 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:
43. How long is the average duration of the phenomena:
44. How often does the phenomenon occur:
45. Do any of the occupants feel the phenomenon 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 its nonsense or not happening:
48. What would you like to see accomplished from our visit?