Full Name (Includes Middle):
Phone Number:
Is This A Cell Phone or Home Phone? Cell
Home
Email Address:
What Are Your Religious Beliefs: (This Is To Allow Us A Better Understanding Of Your Faith Beliefs As It Relates To The Paranormal).
The Location Is My:
If You Have Selected "Other”, Please Explain.
Who Is This Request For? Myself
Friend
Employee
Employer
Address Of Property To Be Investigated:
City:
State:
Zip Code:
If This Is A Business, What Is The Business Name? If not, please type “none”
Today’s Date:
How Did You Hear About Us?
Has There Ever Been A Paranormal Investigation Conducted At This Location? (This Includes Clergy, Psychics/Mediums and/or Demonologists) If Yes, Please Explain When and What Team.
How Large Is The Property?
How Many People Live At This Property?
Current Occupants - Genders and Ages?
Any Cemeteries or Bodies of Water Within 100 Yards? Yes
No
If “Yes”, Please Explain.
How Long Have You Lived/Worked At This Location?
Do You Rent or Own? Rent
Own
If You Do Not Own Your Home or Business, What Is The Owner’s Name and Phone Number and May We Contact Them If Need Be For Research Purposes?
Do You Have An Attic or Basement? Yes - Attic
Yes - Basement
Both
No
Are There Any Pets Inside or Outside Of This Location? Yes - Inside
Yes - Outside
Both
No
Do You Have DSL/WiFi and Can We Use It? Yes
No
Do You or Anyone In Your Family Have A Current or Past History Of Mental Illness? Yes
No
Is Anyone In The Home/Business Using Medicinal or Recreational Drugs? Yes - Medicinal
Yes - Recreational
Both
No
If Yes, Please Describe.
What Year Was This Property Built?
Has There Been Any Renovations Recently At This Location? Yes
No
Do You Know Of Any Previously Documented Paranormal Accounts At This Location? (Newspaper, Testimony, Church, Etc.)
Any Known Historical Battles or Confrontations Near This Location?
On A Timeline, What Is The General History Of The Property?
Describe The Property.
What Is The Size of The Property In Square Feet?
Please Describe In Detail The Activity You Are Experiencing.
How Long Has It Been Occurring?
Do You Feel Threatened or In Danger? Yes
No
Rate The Fear Associated With This Activity. (1 “Not At All" 10 "Terrified")
Are There Any Witnesses To The Activity Besides Occupants? Yes
No
If “Yes”, Please Explain.
Do Pets or Children Notice or React To The Activity?
Please Indicate If You Are Experiencing Now or Have Experienced Before Any Of The Following Paranormal Activity or Events At This Location: (Check All That Apply) Strange Sounds
Mysterious Lights
Mists or Fog-Like Shapes
Strong Unusual Smells or Odors
Unexplainable Shadows
Doors/Windows Opening/Closing
Intense Cold or Hot Spots
Objects Moving On Their Own
Any Other/Additional Activity or Event Not Listed Here
If You Selected “Any Other Activity or Events Not Listed Here" Please Explan.
Has Anyone Had Strange Mood Changes In Specific Rooms or Areas Of The Location? Yes
No
In Your Opinion, What Could Be Some Of The Possible Conventional Causes?
Do You Know If The Previous Occupants Experiencing, or Having Experienced, This Phenomenon? Yes
No
Had Any Problems With Appliances? (Check All That Apply) Televisions
Computers
Radio or Stereos
Clock
Clock Radio
Microwave
Telephones
Lighting
Other
Do Any Of The Residents At This Location Experience Strange Vivid Dreams? If Yes, Please Explain.
Has There Been Any Noticeable Patterns To Any Activity?
Have You or Anyone In Your Family Ever Participated In A Seance? If So, When and Where?
Do You Know If Anyone Has Used A Ouija Board Inside Of The Home To Talk To The Spirits? Yes
No
Has Anyone Had Conversations With Spirits or Entities? If Yes, Please Explain.
How Soon Would You Like Us To Come and Investigate?
What Are You Hoping To Gain By Having Us Investigate For You?
Are You Interested In A Property Cleansing? Yes
No
Would You Like Us To Film Our Investigation For Our Web Series On YouTube? Yes
No
C.P.R.S. believes In A Fully Confidential Investigation. In No Way Will Your Identities or Personal Private Information Be Released To The Public, Should You So Choose. However, If You Would Like Your Identity or Any Personal Private Information To Be Used, You May Designate For Us To Use It For Public Display Below. Yes, You Can Use My Information
No, You Can’t Use My Information
During Our Investigations We Collect Photo, Video, and Audio Evidence. We Would Like To Use This Evidence On Our Websites, Social Media Pages, and YouTube. Yes, You Can Use This Evidence
No, You Can’t Use This Evidence
If We Are Unable To Follow Up With Your Request For An Investigation May We Send Your Information To Another Paranormal Group In Your Area?
By Signing This Electronically, You State That You Understand The Above Application Requests Set Forth By C.P.R.S. and Agree To The Terms That Have Been Listed Within This Investigation Request Form. Please Type Your Full Name As An Electronic Signature.
Today’s Date For Signature.

Form provided by Freedback.

All fields are a required field. You have to fill in every space, if the answer is no on the “If Yes, Please Explain” questions, just type “NO”.

INVESTIGATION REQUEST

Have any pictures, video, or audio files that you want us to review? Email them to ChickashaPRS@gmail.com


​Phone Number: 405-825-3122