Name *
Phone *
Email *
Comment or Message *
long has this been happening to you * Not Applicable 1 year 5 years 10 years 15 years 20 years 25 years 30 years 35 years +
What are your symptoms * Not Applcable Hearing voices (only you can hear, but not the others) Gang Stalking /Organized Stalking (includes skits, tailgating, brighting, vandalizing, neighbors ganging up, job loss - many in a year. Directed at you) Cyber stalking (Computer hacks, phone calls with general ads, repeated hang-up calls in a day, mail/post takes a long time to reach) Direct emotional / mental harassment (at home, workplace, etc) DIrected energy weapons attack (includes V2k, syntheric telepathy, EMF field or energy, conscious hijacking, frequent urination etc) Other (Please specify)
How many people (one who knows you) do you think know about this? * None <5 <10 >10
Which areas of your life have been affected? * Not affected Complete life, financial growth Self esteem / Confidence Education Family life Mind (thinking process, memory, creativity etc) Health (insomnia / sleep altered, amnesia /forgetfulness, diabetes, stress, hypertension high B.P., psychosomatic disorders) Partnerships (ability to deal with people, flow of daily business etc profession / career other (please specify)
Who do you think is doing this to you? * I am not sure Known people or both (CIA, CBI, police, military, RTI etc) FOreign agencies (CIA, FBI, NASA, DHS, etc) Secret societies organized criminals paranormal agents Strangers
What methods have you tried to get rid o the symptoms ? * Not Applicable yoga Healinglike Reiki Over The Counter medicines Herbs Technical solutions (Faraday cage, Mylar clothing, earthing the bed) thinking methods (Changing the routes, passwords, places, rooms) Tanthric remedies (chanting, images, frequency waves) psychiatric treatments Other (Please specify)
What do you think is best for it to do? * Not Applicable Fight back Not sure Ignore Hide some where Organize protests
Have you tried purposely any of these * Not Applicable changed residence changed job / business changed partners changed yourself attempted suicide confronted someone considered disappearing none of the above other (please specify)
Have you tried reporting to any authorities * Not Applicable Local police Govt authorities United Nations Non Govt. Organizations Private investigating agencies
Have you collected any type of evidence * Not Applicable audio recording video recording frequent measurements images log files screenshots MRI scans EEG ECG ECoG None of above none of the above Others (Please specify)
