Carroll Area Paranormal Team Investigation Request
Name:
First and Last
Address ?
Town / City?
State?
Valid e-mail address
Phone number you can be reached at:
What kind of activity are you having? (the more detailed the better)
Who all witnessed this activity? If not living in the home please give name and contact info. (please list all names who were witness to the activity)
Where in the home/business was the activity occuring?
Are there children involved between new born to 16 yrs old?
Yes
No
If your answer to the previous question was yes, please list each child by First Name--age--gender. (i.e. John--6--male).
Are the children being effected?
Yes
No
If the answer in the prior question is yes, please list all events----event time---event place----childs reaction----how many times for each child effected. The more detailed this answer is the better we can serve you and your family.
Please give a general discription of the home or business (i.e. number of bedrooms, basement, business offices, etc)
Has there been recent construction or alterations to the home or business?
Yes
No
If yes please explain.
Has the home or business been blessed or any exorcisms preformed on site? If so please explain and when this happened.
To your knowledge, has anyone died on the property? If so who (if known) and when (if known) and how they passed (if known)
Please list any information known of previous property owners.
Did you or anyone witness to the activity use alcohol in the 24 hours prior to the sighting? f so please indicate how much.
1-2
3-4
5-6
6+
none
Do you or anyone use non-perscription drugs?
Yes
No
Do you use perscription drugs? If so please indicate for what. (all confidential information, check all that apply)
Anxiety
Depression
Mood Altering (for mood swings, etc)
Psychotropic
Headache
Muscle Relaxers
Sleeping Pills
Valium
ADD/ADHD (children)
Steroids
Pain Medication
Other (not listed)
None
If you answered other to the medication list please list that medication here.
Has anyone in your family been diagnosed with a mental illness?
Yes
No
If yes to mental illness please list who and what the diagnosis was.
Do you or the one experiencing activtiy sleep well?
Yes
No
Do you have nightmares? If so please explain them.
Do you feel nervous or watched in the home or business?
Yes
No
Any other information you feel we need to know that has NOT been asked?
Indicates Response Required
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