What is your name?
What is your email address?
What is your age?
(0-120)
What is your gender?
(
M
for male,
F
for female,
T
for transgender )
Was this your first experience like this?
(Y or N)
Have you found yourself unusually sensitive to light lately?
(Y or N)
Have you ever been hypnotized?
(Y or N)
Is the area where the experience occurred, near power lines?
(Y or N)
What was your experience?
We may ask you further questions to get a better understanding of the experience. Thank You.
