Scroll down to find the NDE Questionnaire form (be sure to read Overview and Form Instructions)

Near death experience accounts may be submitted to us (in order of preference):

1. Preferred: via the questionnaire form below.

2. Via e-mail. E-mailing your account is acceptable, but for research it is much better if we can tabulate the results from your completion of the NDE Questionnaire form below. Thanks!

While we greatly appreciate experience contributions, we regret that there can be no monetary compensation to contributors. Confidentiality of all communications will be strictly maintained to the extent desired by the contributor.

Completing this questionnaire will take approximately 45 minutes or longer depending on how much you wish to write. There is a save function that will allow you to save what you have written and come back to it. Make sure to copy and paste the temporary link at the end of the page so you can continue your writing without losing it.

Your willingness to share your experience is vital to the success of this project. We express our heartfelt thanks in advance to those willing to share!
Form Instructions:

1. Please fill out the form below as completely and accurately as you can. Please carefully consider your responses prior to making them.

2. It may be necessary to enter the same information in several boxes. We understand that some questions may ask the same concept in several different ways. This survey is a combination of the most validated and respected questions regarding near death experiences from the top researchers in the world. ALL your responses, even to similarly worded questions, are meaningful and extremely important.

3. The questions that are in red require responses. This is very important… you will not be able to submit the questionnaire until all questions in red have been answered! If you did not respond to one or several red questions, when you press the “Submit” button at the end of the form, there are little green tabs next to the question that needs to be answered. These need to be answered before the form will submit properly. Please fill out all questions to the best of your ability.

4. Please do not forget to press the "Submit" button at the end of the questionnaire or the information will be lost!

5. After you press the "Submit" button upon completing the questionnaire, a review of your responses to the questions will be shown. If you press edit, you go back to the form. If you press confirm, then you have your answers to the question and you can print or save them for your own records. You will also get information about NDERF, how privacy works, and other general information. So please put an e-mail address that allows e-mails to come to you or add and to your approved senders list. If you do not receive the general information, check your spam or please e-mail me with a secondary e-mail address to send this to you.

6. CONSENT: I wish the account of my experience to be placed in the NDERF archives. I understand it may be read by researchers, students, or others approved by NDERF for use of the archives. [NO IDENTIFYING PERSONAL INFORMATION will be given to anyone but Jeff or me. That means that names, e-mails, addresses, and telephone numbers are strictly confidential.] My account may be excerpted or used in full, or data may be drawn from it in conjunction with an NDERF approved study or project, including but not limited to lectures or educational programs, or part of a published article, or in a book. [If you do not wish your experience to be used like this, then please let us know and tell us what use you would prefer. This can be done by e-mail or by check mark in the publishing consent box below. Your comfort in sharing with NDERF is of the utmost importance to us. ] THANKS!!!
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*NOTE: Please make sure that your e-mail service does not place  in spam, delete or reject status - (like hotmail or aol) otherwise we can't contact you. You can also put us on your approved senders list to make sure to get NDERF e-mails. The media regularly contacts NDERF with interest in connecting with those who had near-death experiences and related experiences. Please make sure that we have your updated e-mail contact. Thanks!
Select (or de-select) as many below as apply:
How to Publish
Where to Publish
Race/Ethnicity (check all that apply):
Check all that apply. Skip if none apply. In my occupation, I am currently or have been a:
Circumstances around the time of experience (Check all that apply):
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