UFO Abduction Experiencer Questionnaire

      2.       Age:  Under 20 ( ), 20-30 ( ),  30-40 ( ), 40-50 ( ), 50-60 ( ),  60-70 ( ), 70-80 ( ), over 80 ( )   

3.       Area of Residence: Rural ( ), Small Town ( ), Suburban ( ), Urban ( )

      4.       Time Zone: Eastern ( ), Central ( ), Mountain ( ), Pacific ( )

      5.       Age when first abduction/contact occurred___________

      6.       Age when most recent abduction/contact occurred________________

      7.      How many times do you think you’ve been abducted/contacted? 1 ( ), 2-5 ( ), 5-10 ( ), over 10 ( )

      8.      Was anyone with you when you were abducted/contacted? Yes ( ), No ( )

      9.      If you answered yes to # 8, did they recall the experience? Yes ( ), No ( ) If yes, please explain on back of page.

      10.  Are your abduction/contact recollections conscious? ( ), through dreams? ( ), through hypnosis?

      (  ) Other ( ) (Please check all that apply.)

      11.  Do you consciously recall (not with hypnosis), the observation of an unconventional craft at less than 1000 feet       

            prior to an abduction? Yes ( ), No ( )

      12.  Do you consciously recall (not with hypnosis), the observation of non-human entities immediately prior to an   

            abduction while you were outside your home? Yes ( ), No ( )

      13.   Do you think that your abductions/contacts now ended? Yes ( ), No ( ) Not sure. If yes, at what age?____________

      14.   Have you witnessed paranormal activity in your home? Yes ( ), No ( ) If so, please describe it on the back of this page.

      15.   If you answered yes to # 14, did it begin prior to or after your first abduction? Yes ( ), No ( )

16.   Have you ever received telepathic messages? Yes ( ), No ( )

      17.   If you answered yes to # 16, was it related to an abduction/contact experience? Yes ( ), No ( )

      18.   Do you feel you have been given a gift of healing following the abduction/contact? Yes ( ), No ( )

      19.   Are you more or less “sensitive” or intuitive than you were prior to your abduction/contact?  More ( ), Less ( ), 

             about the same ( )

      20.   Did you develop new psychic abilities after your abduction/contact? Yes ( ), No ( )

      21.  Have witnesses reported that they observed a UFO near your house, vehicle, tent, etc. prior to or during your 

             abduction? Yes ( ), No ( ) If yes, please explain on back of page.

      22.  In what age range did your most frequent abductions/contacts occur? Under 20 ( ), 20-30, ( ), 30-40 ( ), Over 40 ( )

      23.  How frequent were they? __________________________________________________

      24.  What is your typical response to abduction/contact? Curiosity ( ), Fear ( ), Despair ( ), pleasure ( )

      25.  How did you feel after an abduction/contact experience? _______________________________

      26.  Have you awoken with unexplained marks on your body that you suspect were related to an abduction/contact?

            Yes ( ), No ( ) If yes, please describe on back of page.

      27.  If you are a female, have you experienced a gynecological problem that you suspect is related to an abduction 

            experience? Yes ( ), No ( ) If yes, please describe?

      28.  Do you suffer from somnambulism (sleep walking)? Yes ( ), No ( )

      29.  On a daily basis, How would you describe your mood? Happy ( ), Sad ( ), Frequent mood swings ( ), Without unusual 

            highs and lows ( )

      30.  As a child, how would you describe your mood? Happy ( ), Sad ( ), Frequent mood swings ( ), Without unusual highs 

            and lows ( )

      31.  What do you use as a daily coping mechanism to deal with any fear or anxiety due to your abduction experience? 

            ________________________________________________

      32.  Can you feel a foreign object in your body that you suspect is an alien implant? Yes ( ), No ( ) If yes, where is it 

            located? _____________________________________________

      33.  After your abduction/contact did you notice any of the following? More acute hearing? Yes ( ) No ( ). More sensitive 

             to light? Yes ( ), No ( ).  More allergies? Yes ( ), No ( ). More fluctuation in your mood? Yes ( ), No ( )

      34.  Do you ever feel that you are invisible and others can’t see you? Yes ( ), No ( )

      35.  Do you have difficulty falling asleep? Yes ( ), No ( ) Staying asleep? Yes ( ), No ( )

      36.  Have you been diagnosed as having Chronic Fatigue Syndrome or Reactivated Mononucleosis? Yes ( ), No ( )

      37.  What is your blood type? A ( ), B ( ), O ( ), AB ( ) Is it positive? ( ) Negative? ( )

      38.  Do you suffer from Migraine Headaches? Yes ( ), No ( )

      39.  Have you ever suffered burns, hair loss, or conjunctivitis following an abduction? Yes ( ), No ( )

      40.  Have you noticed strange skin rashes immediately following an abduction? Yes ( ), No ( )

      41.  Has your doctor noted changes in your blood chemistry, blood clotting easily, or bleeding too freely after an 

            abduction? Yes ( ), No ( )

      42.   Has your nose bled immediately following an abduction? Yes ( ), No ( )

      43.  Do you crave excessive amounts of salt? Yes ( ), No ( ) If yes, does your bood test indicate a high sodium count Yes ( ),

            No ( )

      44.   Are you aware of having been examined on an alien craft? Yes ( ), No ( )

      45.  Following an abduction/contact, did you ever experience malfunctions of electrical equipment such as lights, digital 

            watches, computers, etc?  Yes ( ), No ( ) If yes, please explain on back.   

      Thank-you for participating.