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Incident Report Form

Questionnaire

If you would like to report a strange or unexplained experience please describe the incident below, complete the required fields, and submit. All information submitted will be kept confidential and will never be shared without express written consent.
  • Optional. You may leave this blank or use a pseudonym if you would like.
  • Describe your experience in as much detail as you would like.
    Please check any / all that apply to your personal background and experiences.
    I will not respond back to you unless you specifically request a follow up to this report.
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