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Share Your Near Death Experience

Before You Start

➤ No payment is offered for participation — Your contribution is voluntary and greatly appreciated, and it helps support ongoing research aimed at better understanding death and what may lie beyond it.
➤ Your privacy will be respected — Personal information such as your name or email address will not be made public or shared.
➤ This questionnaire is detailed and may take approximately 1.5–2 hours to complete — You can save your progress and return later, allowing you to complete it at your own pace. Your answers are stored locally in your browser and never leave your computer unless you choose to submit the form.

Consent and Privacy

By submitting this form, you agree that your experience may be used for research purposes, included in publications, shared on Jakeshaw.net, or shared with third party scientific research organisations. Any material used will not include your name (unless permitted), email address, or other identifying details.

Don’t want your story shared publicly?
➤ Let us know at the end of the questionnaire.

Form Completion Tips

1. Please answer each question carefully and take time to reflect before responding.
2. Some questions may feel similar or repetitive. Please answer all of them, as they help support the research process and improve accuracy.
3. Questions marked with an asterisk (*) are required.
➤ You will not be able to proceed to the next section until these questions are completed.
➤ If any required questions are missed, the form will highlight them after you click 'Next'.

Important Reminders

✅ Be sure to click “Next/Submit Questionnaire” at the end of the form. If the form is not submitted, your responses will not be received.

✅ You can print or save your answers for your personal records if you wish.

✅ If the form asks for your email address and you would like to receive follow-up communication, consider checking your spam or junk folder in case messages are filtered there.

Pro Tip: Save Your Experience First

➤ For longer response sections, consider writing your experience in a Word document or notes app first, then copying and pasting it into the form.
➤ When the form asks for it, you can copy and paste your story into the allocated questionnaire section.
➤ This helps protect your work in case of internet interruptions or technical issues.
Thank you for taking the time to share your experience. Your contribution helps support ongoing research and may also bring insight or comfort to others who have had similar experiences.