General Info Collection Form for New Cases
This questionnaire is a resource for experiencers to report their grid mark occurrence along with any relevant information in a methodical, experiencer-friendly way. If you need assistance or have questions, contact Jennifer via email: experientialdreaming@gmail.com. Please view our dossier ebook for statistical analyses and conclusions through the website home experientialdreaming.com
Date of First Contact with Our Team
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Time
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Method of First Contact with Our Team
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Name
Email Address
Age
Sex
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Occupation
Educational Background
Interests/Hobbies/Passions
Identify anything person may be into
World Location
State of Health
Illnesses, Diagnoses, Medications, Physical fitness
Grid Mark Location
Identify part of body upon which the mark site lay
When was the Mark Discovered?
Include Date/Time
Date of Actual Occurrence
MM
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DD
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YYYY
Estimated Time of Actual Occurrence
(Night, day, between the hours of...)
In what position were you [sleeping] when it appeared?
Clear selection
Who 1st noticed the mark on your body?
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Mark Appearance Details
(general shape, dimensions, # of rows, # of dots, indentation, scoops, grooves)
Sensation at Site
Activity
What were you doing at the time of the mark's appearance?
Any unusual dreams, events, or happenings around time of appearance?
Please describe in as much detail as you can any events or info you deem relevant.
Predisposition to Dreams/OBE's/Altered State Memories
How common is it for you to recall unusual dreams or the like?
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Duration
Estimate Length of Time Before Mark Disappeared
Blood Type
Include Letter(s) and whether positive or negative (i.e.: O+)
Religious/Spiritual Beliefs
General description or Denomination
Personality Profile
Choose some adjectives to describe yourself
AND/OR
Mark all that apply
Possible Causes and Factors
List any guesses or intuitions as to what caused your marks to appear.
Experience/History with Strange Phenomena
Have you encountered any strange phenomena in your life before that may relate to your grid mark occurrence? Please summarize below.
Additional Info
Please identify any additional details that may factor in to our investigation of your case.
Do we have your permission to post a report about your case on our website?
(Only verified posts with sufficient information will be written for publication on the site)
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