CIP Client Information Questionnaire

Central Illinois Paranormal

Client Information Questionnaire
Confidentiality and your right to privacy is very important to us, and it is something that we take very seriously. The information you provide to us is very important. We wish to ensure to you that all information you provide will be held confidential within the organization, except where there is a threat of potential harm to yourself or others. Please feel free to read our Privacy Policy on our website for further information.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State

Zip Code
Phone Number *

Area Code Phone Number
Email *
example@example.com
Names and ages of all other people living/working on site:
Members of Central Illinois Paranormal (CIP) and the National Register of Professional Investigators (NRPI) have to approach cases involving vulnerable clients differently. Select any of the following that might be relevant to you or anyone else who lives or works on the site: *

Under the age of 18 Frail due to old age Has mental health difficulties Has a learning disability Has had a bereavement in the last 12 months that is relevant to what you are experiencing None of the above
Please describe in as much detail as possible what happened that make you contact us: *
Should be Empty:

Central Illinois Paranormal