PCS Case Questionnaire
By filling out the form below you will help us create a pre-evalution of the case in question. All data is completely confidential and will never meet the public eye without your written consent.
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I - Personal Information
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
Address Line 2
Your answer
City *
Your answer
State
Zip Code *
Your answer
Phone Number *
Your answer
Birth Date
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Relationship *
Location of Paranormal Event/Entity: *
Your answer
Date of Incident *
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Date of Incident
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II - Other Witnesses
1 - Full Name:
Your answer
Birth Date:
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Gender
2 - Full Name:
Your answer
Birth Date:
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3 - Full Name:
Your answer
Birth Date:
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4 - Full Name:
Your answer
Birth Date:
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Gender
III - Encounter Questions
1. Can you describe the paranormal experience? *
Your answer
2. If it was an apparition or entity, how far away was it from the person who reported the sighting?
Your answer
3. If it was an experience, what happened? What was the witness doing when it occurred?
Your answer
4. Did the apparition/entity cast a shadow? *
5. Did the entity manipulate or make contact with the subject, make sounds, have a smell, or move any objects?
Your answer
6. Did the entity make eye contact with the witness?
Your answer
7. Did the entity acknowledge anyone present in any way?
Your answer
8. Did the entity speak? If so,what exactly did it say?
Your answer
9. Did the entity move? If yes, explain.
Your answer
10. Could you see an apparition? If so, was it solid or translucent?
Your answer
11. Describe the entity/apparition? (I.E. clothing, coloring, features, etc.)
Your answer
12. How long was the apparition visible?
Your answer
13. Was this the first sighting? If not, explain in as much detail as possible (reviewing the questions above).
Your answer
IV - Conditions at the Time
1. What were the weather conditions like that day?
Your answer
Time:
Time
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2. What were the weather conditions at the time of the sighting?
Your answer
3. Was there any visible lightning or was thunder heard?
Your answer
4. Was there any precipitation? (Rain, snow, hail, fog, mist, etc)
Your answer
5. Were there any noticeable variations in the temperature before, during, or after the sighting?
Your answer
V - Witness Questions
Name: *
Your answer
Birth Date:
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Gender
1. What were you doing before the event occurred?
Your answer
2. What first made you notice the entity's presence?
Your answer
3. What did you think was happening? Or if it was an apparition,what did you think it was?
Your answer
4. Describe what the apparition was doing when you saw it.
Your answer
5. Did you notice any unusual, or out of place smells during the experience? If so, please describe the odors.
Your answer
6. How long did it last, and how did you loose sight of the apparition?
Your answer
7. What was your state of consciousness?
8. Were you feeling tired before the sighting? After? Indicate which and describe.
Your answer
9. Describe what you did before, during, and after the incident.
Your answer
10. Did you attempt to communicate with the entity?
Your answer
11. Were you able to capture any images of the appartition on film or video? Or audio? Please elaborate.
Your answer
12. Did you move toward or away from the apparition?
Your answer
13. Describe your thoughts and emotions during the experience:
Your answer
14. Had you experienced anything like this before? If yes, please explain.
Your answer
15. Had anyone you know ever experienced anything similar to this? If yes, please describe whom, when, and what.
Your answer
VI - General Questions
1. Were there any animals present at the time?
Your answer
2. What were the reactions of the animals before, during, and after the experience?
Your answer
3. Did any objects break before, during, or after the experience?
Your answer
4. Was there any type of physical or sexual attack by the apparition?
Your answer
5. Did you hear any abnormal sounds? If so, please explain and describe.
Your answer
6. Did you hear any voices? If so, what did they sound like and what was said?
Your answer
7. Did anything else unusual happen before, during, or after the experience?
Your answer
8. Have you noticed any patterns in how or when or why the entity or apparition would appear?
Your answer
9. Does the experience happen the same way each time, or is it different with each occurence?
Your answer
VII - Location Questions
Type of Building *
Type of Structure *
Construction Date
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Approximate Building Area:
Your answer
Total Sq. Ft. for plot:
Your answer
Number of Rooms:
Your answer
Attic?
Basement?
1. Is there a lake, pond, river, creek, or natural water source on or near the property? Please describe.
Your answer
2. Are there other physical structures on the property? If so have there been events there as well? Describe.
Your answer
3. In which room(s) do the paranormal activities occur? Or where outside?
Your answer
4. Do any natural occurrences precede, or trigger the paranormal activity? For example high or low pressure, or even physical ailments, such as migraines?
Your answer
5. Do you know the history of the land that this building is upon?
Your answer
6. Does this building or property have a known history of violence? Murder, rape, beatings, etc.
Your answer
7. Has there been a death/deaths in the building, or on the property, that you are aware of?
Your answer
8. Have there been seances or rituals performed, or Ouija boards used inside the building?
Your answer
9. Have you ever had other paranormal researchers investigate this activity? If so, who, and what was the conclusion?
Your answer
10. Has a priest, rabbi,or other religious group ever been called in regarding this situation or previous ones at this location, or dealing with your family? Please explain.
Your answer
11. Have any blessings, cleanings, banishments, or exorcisms been performed inside the dwelling or on the land?
Your answer
12. Do you have any knowledge on the prior residents or former owners of the dwelling or property?
Your answer
VIII - Medical Questions
1. Had you consumed alcohol within 24 hours of the sighting? If so, how long had you been drinking and how much did you consume?
Your answer
2. Did you take any prescription medications within 24 hours of the sighting? If so, what, when, and how much?
Your answer
3. Had you taken any over-the-counter medications within 24 hours of the incident? If so, what, when, and how much?
Your answer
4. Do you wear glasses or contact lenses? If so, were you wearing them at the time of the sighting?
Your answer
5. Do you wear any auditory enhancing devices such as a hearing aid? If so, what kind? And is it worn at all times?
Your answer
6. Do you have any difficulty with your sense of smell? If so, please explain.
Your answer
7. Do you have any difficulty with your sense of touch? If so, please explain.
Your answer
8. Do you have any difficulty with your sense of taste? If so, please explain.
Your answer
9. Have you ever been under the care of a psychiatrist? Explain.
Your answer
10. Have you ever been diagnosed with schizophrenia, bi-polar disorder, split-personality disorder,or borderline personality disorder? Please explain.
Your answer
11. Do you have any known health problems?
Your answer
12. Is your sleep restful and normal or do you have restlessness, insomnia, etc? If so have your sleep habits changed due to paranormal events?
Your answer
13. Do you experience nightmares, astral projection, out of body experiences, or sleep paralysis? Explain.
Your answer
14. Have you been experiencing headaches, migraines, nausea, stomach pains, or dizziness?
Your answer
15. Have you vomited in the last two days? Do you ever vomit before, after, or during an encounter?
Your answer
16. Have you ever had a Near-Death-Experience (NDE)?
Your answer
17. Are you currently under the care of a medical doctor for anything?
Your answer
18. Do you feel depressed, anxious, or nervous? If yes, please explain.
Your answer
19. Do you feel you have an abnormal amount of stress or anxiety in your life? Elaborate.
Your answer
20. Have you had a major life event recently, or has anyone important to you, family or otherwise, recently died?
Your answer
IX - Knowledge of the Paranormal
1. Do you believe in ghosts? Explain.
Your answer
2. Do you believe in psychic or paranormal phenomena?
Your answer
3. What ordinary, normal explanations have you considered? Why do you think the events are paranormal?
Your answer
4. Have you or any others involved had any paranormal experiences in the past? If so when?
Your answer
5. Have you or any others involved had any psychic experiences in the past? If so when?
Your answer
6. Have you, or anyone else who witnessed the event, been interested in paranormal phenomena before this? If so, in what context has it been discussed or pursued?
Your answer
7. What is your theory as to what may be going on? What theories have you discussed with others involved?
Your answer
8. What books or articles have you read about paranormal or psychic phenomena, supernatural, or unsolved mysteries?
Your answer
9. What is your family's religious background? What is your current religious status?
Your answer
10. Have you ever taken courses on the paranormal, psychic, supernatural or spiritual? If so, what, when, and why?
Your answer
11. Has there been any publicity surrounding these events? Has the press found out about what's going on? If so, which members of the media and how can we contact them? If not, can you be sure there won't be any publicity?
Your answer
12. What would you like us to do regarding your case? What are your expectations?
Your answer
13. Would you allow our team to do a serious, scientific investigation of the occurances for you? Understand that we will report what we find, if anything, and provide you with whatever evidence we may find, as well as a solution to your problem.
Your answer
X - General
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