Paranormal Encounters Questionnaire 

This document can be found in Richard Southall's How to be a Ghost Hunter.

By filling out the form below you will help us create a pre-evaluation of the location in question. All data is completely confidential and will never meet the public eye without your written consent.  

Today's date: //

Location Information

History of location (date built, previous occupants, battles or other confrontations near location, other paranormal phenomena, etc.):

List documentation of any previous accounts (newspaper clippings, witness testimony, etc.):

If possible send drawing or map of location to an email and mark areas that show paranormal activity:

Click here to send email.

Occupant Information

Number of occupants at location:

Names, gender and birth dates of occupants: 

Contact information:

Name: Phone: () -

Email Address:

Mailing Address: 

Street: City:  
State:   Zip Code:

How long have you lived at location? months years

Have any of the occupants encountered any of the following? (Check all that apply.)

Voices (if yes, explain:  
)

Smells/Odors (if yes, explain:
)

Shadows (if yes, explain: 
)

Orbs

Smoky Forms

Strong Random Thoughts

  Cold or Hot Spots (if yes, explain:
)

Recent Death of Loved Ones (if yes, give info:
)

Recent Anniversary of Loved One's Death, Birthday, Anniversary, etc.

Rappings or Knockings 

Mood Changes, especially in one room (if yes, explain:
)

Conversations with Spirit (if yes, explain:
)

Door(s) Opening/Closing

Moving/Disappearing Objects

Electrical Disturbances (frequent light bulb burnouts, etc.)

  Puberty of Family Member or Emotional Stress of Adolescents in Area

Renovations in Location (if yes, explain: 

Problems with Appliances:

  • TV

  • Radio/Stereo

  • Computer

  •   Clock or Clock Radio

  • Microwave

  •   Other:

Any accounts of paranormal phenomena at previous residence? If so, explain:

Check to make sure you have filled out all applicable fields  and click the submit button below.

Thank you.

 

 
1