Online Client Questionnaire(1) .pdf

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DCOPRS

DOUGLAS COUNTY, OREGON PARANORMAL RESEARCH SOCIETY
Interview Date

Member

Case Type

Case no.

Property Type

Name: ___________________________________ Telephone no. _____/_____/______ Alt. no. _____/_____/______
Residence Address: __________________________ Apt. # ______ City: ________________, OR Zip Code _______
Mailing address (if different) ______________________ Apt. # ______ City: ________________, OR Zip Code _______
Email: ______________________________ What is the best way to contact you? Home phone



Cell



Email



Please list everyone who lives with you.
L
N

First Name

Last Name
(optional)

Age

Have they also
experienced an event?

Relationship to you

1
2
3
4
5
6
7
8

Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes

self














No
No
No
No
No
No
No
No

Property Information
What type of building is this?
Agriculture
Commercial
Residential
Educational
Government
Industrial
Military
Parking & Storage
Religious
Transport
Other
: _______________________________________________
Do you or are you:
Own building or paying for building
Renting
Living with relatives or friends
How long have you been at this location? _____________________________________________________________
Are the Head of Household? Yes
No
If not, who is? ____________________________________________________ May we contact them? Yes
No
Have you performed any research regarding this location prior to contacting us? Yes
No
If so, please describe your findings and sources: ______________________________________________________
________________________________________________________________________________________________
Would you be willing for our team to conduct an on-site investigation? Yes
Not at this time
No












Events
Did an event lead you to contacting DCOPRS? Yes
No
If yes, when did this event occur: _______________
Please describe what happened, as best you can: _____________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Did others experience this event? Yes ● No
If yes, would they be willing to participate in relation to this questionnaire? Yes
No
Unknown
If so, please provide the name and contact information of the individuals:




First Name

Last Name

Contact Number

Email

To the best of your knowledge, please briefly describe the variety of paranormal events experienced at this
location, i.g. Knocking, Lights flickering, Abnormal behavior in pets, etc.:
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
· ____________________________________________
If you can, please provide a more in-depth explanation of these events here:

DCOPRS

DOUGLAS COUNTY, OREGON PARANORMAL RESEARCH SOCIETY
Approx. date and time of event: ___________________________________________________________
Description of event:
_______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Did others experience the same event? Yes
No
If yes, would they be willing to participate in relation to this questionnaire?


First Name

Last Name

Contact Number

Email

Approx. date and time of event: ___________________________________________________________
Description of event:
_______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Did others experience the same event? Yes
No
If yes, would they be willing to participate in relation to this questionnaire?


First Name

Last Name

Contact Number

Email

Approx. date and time of event: ___________________________________________________________
Description of event:
_______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Did others experience the same event? Yes
No
If yes, would they be willing to participate in relation to this questionnaire?


First Name

Last Name

Contact Number

Email

Approx. date and time of event: ___________________________________________________________
Description of event:
_______________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Did others experience the same event? Yes ● No
If yes, would they be willing to participate in relation to this questionnaire?
First Name

Last Name

Contact Number

Email

What Can We Do For You?
The Douglas County, Oregon Paranormal Research Society is a non-profit organization serving our community.
Our goals are to provide our clients with on-site paranormal investigations, research, cleansing, blessings, and
ultimately a trusted source to which you can turn to with questions and/or concerns.
We are prepared to approach each case with the knowledge and experience needed to document, discover,
debunk and deliver any and all evidence collected. This includes, but is not limited to: EVP, video footage,
pictures, historical information regarding the property, and psychic medium interpretations for those who are
interested.
DCOPRS is also working towards providing assistance from both Religious and/or Spiritual Leaders to those who
seek counsel. We make it a part of our mission to work with and respect all personal views of our clients.

DCOPRS

DOUGLAS COUNTY, OREGON PARANORMAL RESEARCH SOCIETY
Though it is our desire to deliver results, it should be said that we can never guarantee the behavior of the
unknown thus we cannot make any guarantees about the validity and truth behind your experiences or the
success of cleansings. We do guarantee that all events are organized with a scientific outlook and are conducted
under controlled conditions.
Our consultants are volunteers; however, any and all statements made quoting our consultants are the sole
opinion of the individual consultant and do not reflect the opinions or policies, stated or otherwise, of DCOPRS.
No perceived predictions, opinions, information, advice or comments made by our members, psychics, mediums
or clairvoyants should be interpreted as factual or actual. You, the attendee, are responsible for making your own
decisions and it is understood that when our members, psychics, mediums and clairvoyants suggest something
to you, it is an opinion of the consultant, and should not be interpreted as the only course of action.
Which of our services are you interested in?
Investigation ✔ Advice ✔ Cleansing ✔ Blessing ✔ Historical Research ✔ Religious/Spiritual Support ✔ Other
Please briefly describe what you would like DCOPRS to do for you: ______________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________




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