Questionnaire
Date______________

Nature of Paranormal Activity (Brief description of what is occurring)

	

	

	

	

Specific Activity

Auditory Events (Explain in details)	Details
	
	Voices		
	Calling of a name(s)		
	Footsteps 		
	Strange sounds or growling		
	Tapping or knocking		
	Conversations with spirit(s)		
	Other		

Physical Events (Explain in details)	Details
	
	Being touched, shoved, or grabbed 		
	Tugging on clothing		
	Hair on arms or neck standing on end		
	Hot or cold spots		
	Objects moving without apparent cause 		
	Unexplained odors		
	Appliances turning on or off 		
	Doors or windows opening/closing		
	Other		

Visual Events (Explain in details)	Details
	
	Apparitions		
	Smoky or misty forms		
	Shadow figures		
	Unexplained lights		
	Orbs		
	Corner of the eye glimpses		
	Other		

Emotional Events (Explain in details)	Details
	
	Intense random thoughts 		
	Feeling of being watched or followed		
	Mood changes (especially in one room)		
	Unexplained stress or anxiety		
	Unexplained feelings of joy or anger		
	Recent anniversary of a significant event		
	Other		

Historical Data

Residence and Occupant Background
Date Built
(If known)		Previous occupants
(If known)	

Is there a history of paranormal activity at the residence?
		Yes	If Yes, explain:

		No		
Is there documentation of previous paranormal accounts (newspaper clippings, occupant testimony, etc.)?		Yes	If Yes, explain (attach a copy if possible):

		No		
Any accounts of paranormal activity in the current occupant’s previous address?		Yes	If Yes, explain:

		No		
Any known issues with electrical power, heating or cooling systems, or plumbing at the residence?		Yes	If Yes, explain:

		No		
Any known problems with any appliances or electronic equipment at the residence (refrigerator, TV, etc.)?		Yes	If Yes, explain:

		No		
Any history of hoaxing by an occupant or person known to the occupants?		Yes	If Yes, explain:

		No		

Property Background
Did any significant historic event take place on or near the property?
		Yes	If Yes, explain:

		No		
Is there a history of paranormal activity in the vicinity?
		Yes	If Yes, explain:

		No		
Is there documentation of previous paranormal accounts (newspaper clippings, etc.)?		Yes	If Yes, explain (attach a copy if possible):

		No
		
Does the property reside near a significant man-made structure (high voltage power lines, electrical substation, water pumping station, microwave/radio/cell tower, railroad tracks, cemetery, funeral home, Native American burial grounds, etc.)?
		Yes	If Yes, explain:

		No		
Does the property reside near a major natural feature (creek, river, lake, rock formation, forest, etc.)?
		Yes	If Yes, explain:

		No		

Pet Information (List all pets residing at the residence)

_______________________________________________________________________

1.  Length of residency at location ______________________________________________________
2.  Age of site ______________________________________________________________________
3.  History of site (tragedies, deaths, previous complaints, etc.) _______________________________
_________________________________________________________________________________
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4.  Number of rooms at site ___________________________________________________________
5.  Has the site been cleansed, blessed or exorcised? _____________________________________

6.  Has there been any recent remodeling or redecorating? _________________________________
_________________________________________________________________________________
7.  Any occupants interested in or practicing the occult?  (Ouija boards, séances, voodoo, cards, etc.) _________________________________________________________________________________
_________________________________________________________________________________
8.  Any prior investigations conducted? _________________________________________________
9.  Has there been any media involvement? _____________________________________________
10.  Other witnesses besides occupants _________________________________________________
_________________________________________________________________________________
11.  When did the activity begin? _______________________________________________________ 
_________________________________________________________________________________
12.  Does paranormal activity tend to occur at certain times of the day or night?
_________________________________________________________________________________
13.  Have there been any problems with plumbing?  (leaks, flooding, sinks, toilets)
_________________________________________________________________________________
14.  Have any occupants had trouble sleeping or been having nightmares? _____________________
_________________________________________________________________________________
15.  Any pets affected? ______________________________________________________________
16.  Do any occupants feel frightened or threatened? _______________________________________
_________________________________________________________________________________
17.  What do occupants believe is occurring? _____________________________________________
_________________________________________________________________________________
Additional notes, please include any details of recent changes in health: _________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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***THE FOLLOWING QUESTIONS ARE OPTIONAL AND WILL NOT BE SHARED UNLESS CONSENT IS EXPRESSLY GIVEN TO DO SO.  Please specify which of the following may be made publically available.  If none, please write “NONE”___________
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18.  Occupants’ names and ages _____________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
19.  Physical address of site_________________________________________________________
_________________________________________________________________________________
20.  Telephone numbers_____________________________________________________________ 
21.  E-mail address_________________________________________________________________
_________________________________________________________________________________
22.  Any occupants taking medication(s)? _____________________________________________
_________________________________________________________________________________
23.  Any occupants using illegal substances? __________________________________________
24.  Any occupants drinking alcohol heavily? __________________________________________
25. Any occupants currently under psychiatric/psychological care? _______________________
_________________________________________________________________________________
26.  Occupants’ professions/type of work ______________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
27.  Occupants’ religious/spiritual beliefs ______________________________________________
_________________________________________________________________________________

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