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Welcome to Two Trees Hospital for the Cursed, Possessed, and Super Naturally Repressed. Before you see one of our specialists we have a few more questions for you to answer so we can better arrange your treatment. Answer these questions the best you can by circling either the Yes (Y), No (N), or Maybe (M) options, once you have filled out all the questions give your form to the receptionist at the front. Some questions may ask you to give specific answers, please answer those concisely and to the best of your abilities.

If while you are filling out the form and you experience any dizziness, nausea, shakes, or consistent nosebleeds please ask the receptionist so we can quickly efficiently get you to an emergency exorcism room. 

  1. I get an adequate amount of sleep every night   Y    N    M

  2. I am a physically active individual    Y    N    M

  3. I consider myself a spiritual person    Y    N    M

  4. I have been feeling anxious     Y    N    M

  5. I have been feeling depressed     Y    N    M

  6. I don’t feel alone when I physically am     Y    N    M

  7. I feel alone even when others are around     Y    N    M

  8. I have been hearing voices recently     Y    N    M

  9. If so, when did they start?

  10. I see voices     Y    N    M

If so, when did they start?

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  1. I feel light, as if between my shoes and the ground there’s a layer of water  Y    N    M

  2. I’ve woken up in places I don’t remember going to sleep at     Y    N    M

  3. The sound of guitar irritates me     Y    N    M

  4. My skin has moved from one spot of my body to another     Y    N    M

  5. I have intrusive thoughts about hurting myself or others    Y    N    M

  6. My mouth is always dry, even when I drink water     Y    N    M

  7. My tattoos have changed     Y    N    M

  8. Darkness unnerves me     Y    N    M

  9. Darkness comforts me      Y    N    M

  10. Mushrooms have started growing in my home and near my bed     Y    N    M

  11. Sunlight makes me feel uncomfortable     Y    N    M

  12. I know a name I shouldn’t    Y    N    M

  13. I find moth fuzz or spider web in my clothes/on my person often      Y    N    M

  14. Things in my house have not been where I remember leaving them     Y    N    M

  15. I have been climbing trees more than normal     Y    N    M

  16. I feel more empathetic     Y    N    M

  17. Blood interests me     Y    N    M

  18. My blood has changed scent, flavor, sound     Y    N    M

If Yes, in what way? Color, Texture, are things inside it?

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  1. I am constantly aware of others having blood inside them     Y    N    M

  2. I am salivating     Y    N    M

  3. I remember things that didn’t happen to me     Y    N    M

  4. My teeth have changed     Y    N    M

If yes, have they changed locations, density, shape, length, or grown in new places?

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  1. I recently moved into a new house     Y    N    M

  2. Children piss me off more than usual     Y    N    M

  3. The sound of crying is comforting     Y    N    M

  4. I have bought/come into ownership of something new and interesting    Y    N    M

If yes, what is the item?

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  1. The wood of my house has had images appear in the grain of the wood     Y    N    M

If yes, what are the images of, are they violent?

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  1. My silver jewelry has made me feel uncomfortable     Y    N    M

  2. I feel more energized at night     Y    N    M

If yes, Is there a specific thing about these nights? A new/full moon, rain, etc?

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  1. Children stare at me often     Y    N    M

  2. Domesticated animals act nervous around me     Y    N    M

  3. I found a card for this clinic in my house or on the road     Y    N    M

  4. A pleasant Irishman referred me to the clinic after joining me in a religious activity?    Y    N    M

If yes What was the activity?

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  1. I become more flexible recently but haven’t been stretching     Y    N    M

  2. The text of my books changes     Y    N    M

If yes, does the ink bleed, do words change, do images appear in the words?

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  1. I lose control of my body in small ways, such as twitches or scratching      Y    N    M

  2. I’ve grown new body parts      Y    N    M

If Yes, what have you grown?

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  1. I bought something from a door to door salesman recently     Y    N    M

If yes, what did you buy? What did the salesman look like?

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  1. An animal Attacked me recently      Y    N    M

If Yes or Maybe, what elaborate

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  1. I wake up with bugs nesting on me      Y    N    M

If Yes or Maybe, what type of bug, where are they nesting, are they building a physical nest or simply clumping together?

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  1. I have attempted or committed a violent act recently

If yes, elaborate

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Be sure to leave this form with the receptionist and make sure no one other than yourself turns it in. If you find you are unable to leave your chair at this point, politely call for the receptionist to bring you water and they will come assist you. 

Thank you again for choosing Two Trees Clinic and we look forward to helping you!

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