I understand that this questionnaire is used to determine whether an investigation is appropriate or will be approved, and that submission does not guarantee an investigation.  ^*

Yes, I understand.

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Personal & Household Information

This section collects identifying and demographic information necessary for case screening, investigator safety planning, and research analysis. All information is kept confidential and used in accordance with ECPS data handling policies. Completion of this section is required for consideration.

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Please fill the following:^*

First Name^*

Last Name^*

Email^*

Phone Number^*

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Please fill the following:^*

Preferred Name:

Date of Birth:^*

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Preferred method of contact?^*

Phone

Text

Email

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I consent to being contacted by ECPS regarding this screening request.  ^*

Yes, I consent.

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Demographic & Background Information

The following questions are optional and are used solely for aggregated research, historical context analysis, and investigator preparation. Responses are not used to approve or deny an investigation and may be skipped without penalty.

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Sex assigned at birth:

Female

Male

Intersex

Prefer not to say

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Gender identity:

Woman

Man

Non-binary

Genderqueer / gender non-conforming

Prefer not to say

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Ethnicity / Race:

Select all that apply.

White

Black or African American

Hispanic or Latino

Asian

Native American or Alaska Native

Native Hawaiian or Pacific Islander

Middle Eastern or North African

Prefer not to say

Other

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Are there any cultural, spiritual, or belief systems that influence how you interpret or experience the reported phenomena?

/

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Property Identification & Residence Characteristics  

This section collects factual information about the property to support investigation planning, environmental assessment, and research analysis. Please answer as accurately as possible.

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Please enter your complete property address.^*

Address^*

Address line 2

City^*

State^*

Zip^*

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Is this the primary residence associated with the reported experiences?^*

Yes

No

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Type of Residence:^*

Single-family home

Apartment

Duplex

Multi-family home

Mobile home

Condominimum / townhouse

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Do you own or rent this property?^*

Own

Rent

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If renting, is the property owner or landlord aware of reported issues?^*

This question applies only to rented properties.

Yes

No

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What is the approximate year the residence was built?^*

An estimate is acceptable if the exact year is unknown.

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Length of time living or residing at this location (years/months)?^*

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How many people regularly live in the residence (including yourself)?^*

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Number of Floors (above ground):^*

Do not include basements or below-ground levels.

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Is there a history of mice or pests on the property?^*

Yes

No

Unsure

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Basement/Foundation Type:^*

Select the option that best describes the primary foundation of the structure.

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Is the basement finished or unfinished?^*

Finished

Partially finished

Unfinished

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How is the basement primarily used?^*

Select all that apply.

Storage

Living space

Laundry / utilities

Mechanical / HVAC

Workspace

Other

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How often is the basement regularly accessed?  ^*

Daily

Weekly

Rarely

Almost never

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Is there an attic or loft space present in the structure?^*

Include unfinished or inaccessible spaces.

Yes

No

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Is the attic or loft accessible?^*

Yes

No

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How is the attic primarily used?

Select all that apply.

Storage

Living space

Mechanical / utilities

Unfinished / unused

Other

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How often is the attic or loft regularly accessed?^*

Daily

Weekly

Rarely

Almost never

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Are there any areas of the property that are avoided, restricted, or intentionally unused?^*

Yes

No

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If yes, what areas?^*

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Has the property undergone renovations or major repairs?^*

Yes

No

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Approximate timeframe of renovations or repairs:^*

An estimate is acceptable (e.g., “within the last 5 years”).

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Which areas or systems were affected during renovations or repairs?^*

Electrical

Plumbing

Structural

HVAC (heating / cooling)

Basement

Attic

Interior finishes

Other

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Please briefly describe the scope or nature of the renovations or repairs:

/

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Are any renovation-related issues ongoing or unresolved?

Yes

No

Unsure

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Household Member 1

This section collects information about the primary resident completing this questionnaire. Information is kept confidential and used only for screening, safety planning, and research purposes.

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Contact Information^*

First Name^*

Last Name^*

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What is your date of birth?^*

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Relationship to primary contact:^*

Self

Spouse / partner

Child

Parent

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Occupation:^*

Please list current occupation or primary role (e.g., teacher, software engineer, retired, etc.).

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Approximate time spent in residence based on average weekly presence:^*

Full-time

Part-time

Occasional

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Additional Household Members

Complete this section only if applicable. If fewer household members live in the residence, leave this section blank and click Next.

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Full names, ages, occupations, & relationships:

Please list additional household members not captured above (names, ages, occupations, and relationships).

/

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Are there any animals or pets regularly living in the residence?^*

Yes

No

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Type(s) of animals present:^*

Dog(s)

Cat(s)

Bird(s)

Reptile(s)

Rodent(s)

Livestock

Other

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Where are animals primarily kept?^*

Indoors

Outdoors

Both

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Have you noticed unusual or unexplained behaviors in pets?^*

Yes

No

Unsure

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Do animals have access to sleeping areas?^*

Yes

No

Unsure

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Are overnight guests present in the residence on a regular basis?^*

Yes

Occasionally

Rarely

No

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Please briefly describe (e.g., frequency or typical relationship):^*

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Daily Patterns & Environmental Interaction

This section helps us understand how the residence is used on a day-to-day basis.

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Approximately how much time do you spend in the residence on a typical day?^*

Less than 4 hours

4-8 hours

8-12 hours

More than 12 hours

Varies significantly

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Which areas of the residence do you spend the most time in?^*

Select all that apply.

Bedroom(s)

Living room

Kitchen

Basement

Attic / loft

Home office / workspace

Other

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When are you most often present in the residence?^*

Daytime

Evening

Overnight

Varies

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Where do you typically sleep?^*

Bedroom(s)

Basement

Attic / loft

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Have there been any significant changes to your daily routine within the past year?^*

Yes

No

Unsure

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If yes, briefly describe (e.g., work schedule, sleep patterns, time spent at home):^*

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Reported Experiences & Unexplained Phenomena

This section asks about experiences the household has perceived as unusual or unexplained. Responses are self-reported and used to guide investigation planning and contextual analysis.
There are no right or wrong answers.

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Please briefly describe where activity is most noticeable:^*

/

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Have any of the following sounds been reported?^*

Hearing voices or whispering

Hearing footsteps with no visible source

Tapping, knocking, or banging sounds

Calling of a name

None of the above

Other

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Please describe the sounds (location, timing, frequency):^*

/

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Have any visual phenomena been reported?^*

Shadows or shadow figures

Apparitions or full figures

Smoky or mist-like forms

Peripheral movement

Orbs or unexplained lights

Objects appearing or disappearing

Unknown animals / entities

None of the above

Other

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Please describe what visual phenomena were seen:^*

/

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Have any physical or environmental changes been reported?^*

Sudden temperature changes

Feeling touched (non-sexual)

Pressure or presence sensations

Objects moving or rearranging

Doors or cabinets opening / closing

Electrical disturbances

Unexplained odors

None of the above

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Have any experiences felt physically invasive or distressing?^*

Yes

No

Prefer not to answer

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Please describe only what you are comfortable sharing:^*

/

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Have any emotional or psychological effects been associated with these experiences?^*

Sudden mood changes

Anxiety or fear without a clear cause

Feeling watched or followed

Difficulty sleeping

Recurring dreams or nightmares

Intrusive or distressing thoughts

None of the above

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Please describe timing or patterns, if known:^*

/

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How often do these experiences occur?^*

Daily

Weekly

Monthly

Rarely

One-time event

Unpredictable

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Do the experiences tend to occur around specific times?^*

Select all that apply.

Early morning

Afternoon

Evening

Late night

During sleep / upon waking

No consistent timing

Unsure

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How did you initially respond when these experiences were first noticed?^*

Curiosity

Fear

Confusion

Indifference

Unsure / mixed

Other

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Is there a perception that experiences are associated more strongly with one individual?^*

Yes

No

Unsure

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If yes, who?^*

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Have these experiences been reported by more than one individual in the household?^*

Yes

No

Unsure

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If yes, please indicate whether experiences were reported to you independently or discussed beforehand.^*

/

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Were any objects, items, or materials left behind by previous occupants that are considered significant by the household?^*

Yes

No

Unsure

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Please describe the item(s), their location, and why they are considered significant:^*

/

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Have any spiritual, religious, or cultural practices been performed in the residence related to these experiences?^*

Examples include blessings, cleansings, prayers, rituals, ceremonies, or similar practices.

Yes

No

Unsure

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What type(s) of practice were performed?^*

Select all that apply.

Religious blessing

Cleansing (smoke, water, sound, salt)

Prayer or meditation

Cultural or ancestral practice

Ritual or ceremony

Practitioner-led service (clergy, spiritual advisor)

Other

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Who performed the practice(s)?^*

Household member

Religious leader / clergy

Spiritual practitioner

Cultural elder

Energy worker / Reiki Master

Other

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Approximately when was the practice performed?^*

Estimates are acceptable.

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Was the practice performed once or multiple times?^*

One time

Multiple times

Ongoing

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Did the household notice any change following the practice?^*

Activity decreased

Activity increased

No noticeable change

Unsure

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Have any non-spiritual changes been attempted to address the experiences?^*

Select all that apply.

Repairs or maintenance

Pest control

Changes to lighting

Changes to sleep routines

Soundproofing / noise mitigation

None

Unsure

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If yes, please specify:^*

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When were these experiences first noticed?^*

Approximate timeframe is acceptable.

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Did any significant life events, renovations, or changes occur around the time the activity began?

Yes

No

Unsure

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If yes, please describe:^*

/

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Are there children in the household who have reported unusual experiences?^*

Yes

No

N/A

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Please describe what was reported:^*

/

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Do you have a personal belief about the cause of these experiences?^*

Yes

No

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Please describe your belief:^*

/

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How are these experiences affecting the household, and what is your primary goal in requesting an investigation?^*

/

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Health & Medical Context

The following questions are optional and are asked to help provide appropriate context, ensure investigator safety, and guide follow-up discussions. Responses are confidential and are not used to diagnose, label, or dismiss reported experiences.

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Have you consulted a medical or mental health professional regarding any of the experiences described?^*

Yes

No

Prefer not to say

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Was this consultation related to physical health, mental health, or both?^*

Physical health

Mental health

Both

Prefer not to say

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Are you currently taking any prescription medications?^*

Yes

No

Prefer not to say

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Please list medications only if you are comfortable doing so.

/

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Are any substances currently used that may affect sleep, perception, or alertness?^*

Alcohol

Cannabis

Prescription sleep aids

Stimulants

Prefer not to say

None

Other

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Have there been any recent changes in medications or substance use within the past 6 months?^*

Yes

No

Prefer not to say

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Have sleep patterns been significantly disrupted during the time these experiences have been reported?^*

Yes

No

Unsure

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Have there been any major life stressors or significant events during the time these experiences began or intensified?^*

Yes

No

Prefer not to say

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Have there been any recent head injuries, concussions, seizures, or neurological events?^*

Yes

No

Prefer not to say

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Investigation Requirements & Site Readiness

We may be unable to proceed with an investigation if these requirements are not met. These questions help ensure investigator safety, legal compliance, and operational feasibility.

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Has the property owner or legal resident granted permission for the investigation?^*

Yes

No

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Does the client agree to sign all required waivers, releases, and consent forms?^*

Yes

No

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Will all non-essential persons be off the property during the investigation?^*

Yes

No

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Will pets be secured or removed from investigation areas during the investigation?^*

Yes

No

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Are there any known pest infestations (fleas, ticks, rodents, insects) in the residence?^*

Yes

No

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Are there any known environmental hazards present in the residence (e.g., mold, asbestos, structural instability, aggressive animals, unsafe wiring)?^*

Yes

No

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Please briefly describe:^*

/

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Will any weapons, firearms, or controlled substances be secured or removed prior to the investigation?^*

Yes

No

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Is the home able to be adequately heated or cooled during the investigation?^*

Yes

No

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Is the residence generally clean and safe for investigators to move through?^*

Yes

No

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Is there seating available for investigators during extended periods?^*

Yes

No

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Is there adequate parking available for at least three or four investigators?^*

Yes

No

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Are there any areas of the residence that should not be accessed during an investigation?^*

Yes

No

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Client Expectations & Boundaries

The following questions are intended to establish clear expectations, ensure safety, and define the scope and limitations of the investigation. These acknowledgments help protect both the client and investigators and ensure a respectful, professional process.

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Do you understand that paranormal investigations may not produce definitive explanations, evidence, or conclusions?^*

Yes

No

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Understanding of Investigation Outcomes:

Paranormal investigations focus on documenting reported experiences and environmental conditions. Outcomes may be inconclusive, and the absence of evidence does not invalidate personal experiences.

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Do you understand that investigators do not diagnose medical, psychological, or spiritual conditions?^*

Yes

No

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Do you understand that investigators will not intentionally provoke, taunt, challenge, or attempt to escalate reported activity?^*

Investigative methods prioritize observation, documentation, and safety.

Yes

No

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Do you understand that investigators will approach reported experiences neutrally and respectfully, without affirming or dismissing personal beliefs?^*

Yes

No

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Do you understand that client participation during the investigation may be limited or restricted for safety and data integrity?^*

Investigators may request quiet periods, room restrictions, or limited movement during certain phases if applicable.

Yes

No

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Do you understand that audio, photo, video, or environmental data may be recorded during the investigation for documentation purposes?

Yes

No

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Do you understand that discussing or revisiting reported experiences may be emotionally challenging?^*

Investigators will not pressure participants to continue discussions they find distressing.

Yes

No

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Do you understand that investigators cannot guarantee resolution, cessation, or explanation of reported experiences?^*

Yes

No

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If an investigation moves forward, do you agree to contact the investigation team if you experience any concerns, discomfort, or safety issues related to the investigation?

Yes

No

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By proceeding, do you acknowledge and accept the expectations and boundaries outlined previously?^*

Yes

No

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Thank you for your submission.

Thank you for taking the time to complete our intake questionnaire. We appreciate your willingness to share your experiences with us.

Your responses will be reviewed by the Eastern Connecticut Paranormal Society as part of our case screening process. While submission does not guarantee an investigation, it helps us determine how we may be able to assist you moving forward.

If we need any additional information, a team member will reach out. Thank you for your patience and for trusting us with your story.

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ECPS Investigation Screening & Research Questionnaire

Personal & Household Information

Demographic & Background Information

Property Identification & Residence Characteristics

Household Member 1

Additional Household Members

Daily Patterns & Environmental Interaction

Reported Experiences & Unexplained Phenomena

Health & Medical Context

Investigation Requirements & Site Readiness

Client Expectations & Boundaries

Understanding of Investigation Outcomes:

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ECPS Investigation Screening &amp; Research Questionnaire

Personal &amp; Household Information

Demographic &amp; Background Information

Property Identification &amp; Residence Characteristics&nbsp;&nbsp;

Household Member 1

Additional Household Members

Daily Patterns &amp; Environmental Interaction

Reported Experiences &amp; Unexplained Phenomena

Health &amp; Medical Context

Investigation Requirements &amp; Site Readiness

Client Expectations &amp; Boundaries

Understanding of Investigation Outcomes:

Thank you for your submission.

ECPS Investigation Screening & Research Questionnaire

Personal & Household Information

Demographic & Background Information

Property Identification & Residence Characteristics

Daily Patterns & Environmental Interaction

Reported Experiences & Unexplained Phenomena

Health & Medical Context

Investigation Requirements & Site Readiness

Client Expectations & Boundaries