Name
Street Address:
City:
State:
Phone Number
E-mail address
Gender male/female
Age
1.  Describe exactly what was seen, heard felt
and even smelled.
2.  Describe what you think happened:
3.  Describe your theory as to the cause of the
disturbance:
4.  Do you consider yourself religious and if so
what are you?
5.  Where is the location of the disturbance?
6.  What was the duration of the disturbance?
7.  What was the time of the disturbance?
8.  Please list any birthdays, anniversaries and
other significant dates:
9.  Are there any children in the house, if so
list their names and ages:
10.  Describe any physical experiences:
11.  Do you have any pets?
12.  Do you or anyone in the house take drugs
(prescriptions, over the counter, or illegal)?
13.  Have any other paranormal groups or
clergy men been contacted?
14.  Has there been any witnesses to the
activity?
15.  Has there been any recent remodeling?
16.  Have there been any odors, sounds,
voices, levitations or any physical attacks?
17.  Have there been any movements of
objects or noticeable cold or hot spots?
18.  Has there been any problems with
electrical appliances?
19.  Any occupants having insomnia or
nightmares?
20.  Any additional comments that you would
like to make:
                     PSI Paranormal Scientific Investigators
This form is meant to collect information about your paranormal activity, please fill it out to the
best of your ability.  We understand this is time consuming but it helps us better understand
your situation.  If you need help or don't understand a question leave it blank and we will help
you with it after we conduct our interview.