I will leave out all basic questions regarding name, address, etc...

1. Religion

2. Pastor

3. Pastor contact info

4. Church attended

5. church contact info

6. Description of the situation

7. Prescription drugs being taken

8. Vitamin supplements taken

9. Physician's contact info

10. Psychiatrists contact info

11. Counselors contact info

12. General health

The following are yes or no questions mostly

1. I attend a Christian fellowship on a regular basis? yes or no

2. I read the bible on a daily basis? yes or no

3. I am a born again Christian? yes or no

4. I have been baptized in the spirit? yes or no

5. I drink alcohol? yes or no

6. I hear voices? yes or no

7. I have been gang stalked? yes or no

8. I feel like I am being watched? yes or no

9. I have night terrors? yes or no

10. I have realistic terrifying nightmares? yes or no

11. I have night visitors? yes or no

12. I hear a humming/engine sound in my ears? yes or no

13. I feel vibrations on/in my body? yes or no

14. I am being touched by something that I cannot see? yes or no

15. I find marks on my body that I cannot account for? yes or no

16. I have been abducted? yes or no

17. I have seen ufo's? yes or no

18. I have experienced blackouts or missing time? yes or no

19. I have used a ouija board? yes or no

20. I have used tarot cards or runes? yes or no

21. I have attempted suicide? yes or no

22. I have channeled guides? yes or no

23. I have astral traveled/out of body experience? yes or no

24. I have remote viewed? yes or no

25. I possess idols, crystals, talismans, mojo/gri-gri bags? yes or no

26. I have been hypnotized? yes or no

27. I practice transcendental meditation? yes or no

28. I practice energy work (Reiki, Qigong, etc) yes or no

29. I have attempted pagan cleansing rituals? yes or no

30. have them describe the ritual performed

31. I have tried vampirism? yes or no

32. Pagan/Satanist/Wiccan? yes or no

33. Vodou/Santeria? yes or no

34. I have friends who practice witchcraft? yes or no

35. I have invited/requested spiritual forces or extraterrestrials to aid me? yes or no

36. I have brought home rocks/dirt/sand while traveling abroad? yes or no

37. have them tell you all locations

38. I have sacrificed animals? yes or no

39. If yes why and for what religion and ritual

40. I talk to the dead? yes or no

41. I have been levitated? yes or no

42. I have participated in role playing games? yes or no

43. have them describe what type of role play, bdsm/vampirism/magic

44. What kind of music do you like to listen to?

45. What drugs have you used?

46. Have you been diagnosed with schizophrenia , bipolar, multiple personality, etc

47. describe your faith?

48. Parents history (divorce, alcoholism, murder, incest, neglect or abuse, pedophilia, drug use, witchcraft, religions, diseases, mental health, suicides, depression, etc..)