17. Have you ever been close to death and at that moment had an experience
of yourself or your surroundings that was seemingly real but totally
unlike the way you commonly experience things?
Yes 
No
If you answered no to the preceding question, you have finished the
questionnaire. You may send it now by clicking the "Send Questionnaire" button at the bottom of this page.
Click to go there.
If you answered yes to the preceding question, you have had a near-death
experience (NDE). Please continue with the questions below.
18. Please tell us about your near-death experience in
as much detail as possible. If you have had more than one NDE, describe
the most outstanding and use it for the questionnaire:
19. If you recall, please state the hour, date, and place of your near-death
experience. If you don't know the exact hour, date, or place, and if
you can recall, write the approximate time of day, approximate time of
year, approximate year, approximate place:
20. Please indicate how important or meaningful your NDE was to you.
21. Please describe your emotions during the NDE:
22. During your NDE, were you aware of actual things that were happening
beyond the reach of your familiar five senses and that you could not
know about by normal means?
Yes 
No
23. During your NDE, were you aware of things in the future that you could
not have known about by normal means?
Yes 
No
24. During your NDE, did you have the experience of leaving your body and of
observing things from another place?
Yes 
No
25. During your NDE, did you sense the presence of one or more deceased
persons?
Yes 
No
26. Since your near-death experience, have you been aware of actual things
that were happening beyond the reach of your normal senses and that you
could not know about by normal means?
Yes 
No
27. If you answered yes to the preceding question, how does the frequency of such awareness since your
NDE compare with the frequency of these experiences before your NDE?
Fewer 
The same 
More frequent
28. Since your near-death experience, have you been aware of things in the future that you could not have known about by normal means?
Yes 
No
29. If you answered yes to the preceding question, how does the frequency of such awareness since your NDE compare with the frequency of these experiences before your NDE?
Fewer 
The same 
More frequent
30. Since your near-death experience, have you had the experience of leaving
your body and of observing things from another place?
Yes 
No
31. If you answered yes to the preceding question, how does the frequency of such awareness since your
NDE compare with the frequency of these experiences before your NDE?
Fewer 
The same 
More frequent
32. Since your near-death experience, have you had the experience, when
awake, of sensing the presence of a deceased person?
Yes 
No
33. If you answered yes to the preceding question, how does the frequency of such awareness since your
NDE compare with the frequency of these experiences before your NDE?
Fewer 
The same 
More frequent
34. Since the near-death experience, have you noticed any change in your
relationship to other people?
Yes, I feel more remote from others
No, I feel the same toward others as I did before the experience
Yes, I feel more connected to others
35. Since the near-death experience, have you noticed any change in your
relationship to your physical environment?
Yes, I feel more separated from things in my environment
No, I feel the same as I did before the experience
Yes, I feel more connected to things in my environment
36. Since your NDE, have you experienced any physical or medical changes?
Yes 
No
If yes, please describe: