Client Questionnaire
for Paranormal Encounters
Interview Questions (Revised 5/03/10)
No Copy Right Feel free to use and distribute.
Case #: _____________________________ (Leave blank)
Date of Contact: ___/___/___ (Leave blank)
Name of Investigator(s): ______________________________________________ (Leave blank)
Date of Interview: ___/___/___ (Leave blank)
Name of Investigator(s): ______________________________________________ (Leave blank)
Date of Investigation: ___/___/___ (Leave blank)
Name of Investigator(s): ______________________________________________ (Leave blank)
Location Information
(All information on this form will be kept confidential)
Physical Address of Investigation:
Address: ______________________________________________________________________
City/State/Zip Code: ____________________________________________________________
History of location (date built, previous occupants, battles or other confrontations near location,
other paranormal phenomena, etc.):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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 ______________________________________________________________________________
Documentation of any previous paranormal accounts (newspaper clippings, occupants' testimony,
etc.)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Attach drawing or map of location to sheet and mark areas that show paranormal activity.
Occupant Information
Number of occupants at location:
Currently: ____________
During paranormal experiences: ____________
Names, gender, and birth date of occupants (add additional to back of sheet or attach):
1. ________________________________________________________________ ___/___/___
2. ________________________________________________________________ ___/___/___
3. ________________________________________________________________ ___/___/___
4. ________________________________________________________________ ___/___/___
5. ________________________________________________________________ ___/___/___
Contact information of occupants:
Phone: _______________________ E-Mail address: ___________________________________
Mailing address:
Check here if it is the same as “Physical Address of Investigation” on Page 1)
Address: ______________________________________________________________________
City/State/Zip Code: ____________________________________________________________
How long have occupants lived at location?: __________________________________________
Religion: ______________________________________________________________________
Have any of occupants encountered any of the following? (Check all that apply):
(If you need extra space to respond to any of these questions, please provide on a separate sheet and write
the question you are responding to with your answer).
Voices (if yes, explain: _________________________________________________________)
Calling of your name from no apparent source.
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 Smells/Odors (if yes, explain: ___________________________________________________)
Being touched (shoulder, arm, etc.).
Tugging of clothes.
Shadows (if yes, explain: _______________________________________________________)
Apparitions (any specific time of day?: ____________________________________________)
Unexplained lights.
Orbs.
Smoky forms.
Sudden unexplained breezes.
Hair on arms and neck standing on end.
Strong random thoughts.
Strong feelings of being watched or followed.
Cold or hot spots (if yes, explain: ________________________________________________)
Recent death of loved on (if yes, give information: ___________________________________
___________________________________________________________________________
Recent anniversary of loved one's death, birthday, anniversary, etc. (if yes, give information: _
___________________________________________________________________________
Tapping or Knockings from no source.
Mood changes, especially in one room (if yes, explain: _______________________________)
Conversations with spirits (if yes, explain: _________________________________________)
Door(s) opening/closing.
Moving/disappearing/rearranged objects.
Furniture rearranged.
Movement out of the corner of your eye (usually when you are alone).
Electrical disturbances (frequent light bulb, burnouts, etc.).
Appliances on/off.
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/Clock Radio
Microwave
Other: ________________________________________________________________
Are there any accounts of paranormal phenomena occurring at occupants' previous residence? If
so, explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Any history of hoaxing involved with occupant or family member? If yes, explain:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Please print, complete, and contact us.
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