PC-PRIME - DEAR MIND BEAVER COUNTY

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The following screen asks about your personal experiences. It asks about your sensory, psychological, emotional and social experiences. Some of these questions may seem to relate directly to your experiences and others may not.

Based on your experiences within the past year, please indicate how much you agree or disagree with the
following statements. Read each question carefully and circle the answer that best describes your
experience. Please answer all questions.

By Completing this Survey, you consent that you may be contacted in regards to your results.

Email *

Please Enter Today's Date *

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Please Enter Your First Name *

Please Enter Your Last Name *

Please Enter Your Date of Birth *

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Please List Your Gender

Female

Male

Prefer not to say

Other:

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Would you like a call regarding your submission to discuss your results? *

Yes

Maybe

I think that I have felt that there are odd or unusual things going on that I can't explain *

Definitely disagree

Definitely agree

I think that I might be able to predict the future. *

Definitely disagree

Definitely agree

I may have felt that there could possibly be something interrupting or controlling my thoughts, feelings or actions. *

Definitely disagree

Definitely agree

I have had the experience of doing something differently because of my superstitions. *

Definitely disagree

Definitely agree

I think that I may get confused at times whether something I experience or perceive may be real or may just be part of my imagination or dreams. *

Definitely disagree

Definitely agree

I have thought that it might be possible that other people can read my mind or that I can read others' minds. *

Definitely disagree

Definitely agree

I wonder if people may be planning to hurt me or even may be about to hurt me. *

Definitely disagree

Definitely agree

I believe that I have special natural or supernatural gifts beyond my talent and natural strengths. *

Definitely disagree

Definitely agree

I think I might feel like my mind is "playing tricks" on me. *

Definitely disagree

Definitely agree

I have had the experience of hearing faint or clear sounds of people or a person mumbling or talking when there is no one near me. *

Definitely disagree

Definitely agree

I think that I may hear my own thoughts being said out loud. *

Definitely disagree

Definitely agree

I have been concerned that I might be "going crazy". *

Definitely disagree

Definitely agree

A copy of your responses will be emailed to the address you provided.

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