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Name	*
Location (City/State)	*
Known History of the location
Number of Occupants/Employees
Age of Occupants
Email Address where we can reach you	*
Phone number where we can reach you	*
How long have you lived or worked at the location?	*
Has anyone experienced...	*	Voices Odors Shadows Apparitions Orbs Smokey Forms Cold/Hot spots Noises such as rapping or knocking Other Noises Conversations with a spirit Doors opening or closing on thier own Moving/Disappearing Objects Strange/Random Thoughts Sudden or unusual mood changes, especially in one room/location None of the above
Does this coincide with...	*	A recent death of a loved one the Anniversary of a loved one's death the Birthday of a loved one who has passed on Recent renovations None of the above
Have you noticed...	*	Electrical disturbances Problems with TV Problems with Radio/Stereo Problems with computer Problems with Clock or Clock radio Problems with Microwave Problems with Other appliances None of the above
Have you experienced similar at a previous residence?	*	Yes No
Please explain any responses to the four questions above
Do you have any pets	*	Yes No
Are the pets effected by the activity?		Yes No
Occupations of Occupants	*
Religious Beliefs of Occupants
Has anyone used Ouija boards or other occult items in the location?	*	Yes No
If yes, when (before or after the activity started) and what was the result?
Are there any known electrical problems with the property	*	Yes No
Are there any known plumbing problems in the property?	*	Yes No
Are there any known structural problems in the property?	*	Yes No
How often does the activity occur?	*
Is the activity cyclical (does it happen during specific times of the year or month)	*	Yes No
If yes, when is the activity most noticable?
How do the occupants/owners/employees feel about the activity	*
What would you like to happen as a result of the investigation?	*
Will it be a problem for the investigation to occur overnight?	*	Yes No
Does the activity seem to focus on or around one person	*	Yes No
If so, Who (first name, relationship, age, sex)
Please take a moment, in your own words, to tell us what is happening	*
Is there anything else we should know?