File a Report

DEW Police – Documentation • Support • Advocacy

The DEW Police Civilian Incident Report is a confidential intake process designed for individuals experiencing unusual physical, neurological, or sensory disturbances, including patterns similar to those described in Havana Syndrome / AHI Anomalous Health Incidents.

This report provides civilians with a structured way to document their experiences, create an official record, and contribute to a growing body of information used to support research, public awareness, and informed policy discussions.

Purpose of This Report

By completing this intake questionnaire, you help:

  • Establish a formal, time-stamped record of your experiences
  • Identify patterns, trends, and environmental factors
  • Support data-informed advocacy and public health awareness
  • Assist in efforts to improve access to medical evaluation and resources
  • Contribute to a broader understanding of unexplained neurological symptoms

COPY QUESTIONS BELOW AND PASTE INTO THE BODY OF YOUR EMAIL, then email to us at: info@dewpolice.com.

  • 1. Basic Information
    Name
    Email
    Phone
    City / State
    Age or Date of Birth
    Who lives with you?

    2. When Did This Start?
    When did you first notice symptoms?
    When was your most recent experience?
    What time of day does it happen most?

    3. What Are You Experiencing?
    (Check all that apply)
    Sounds / Communication
    Hearing voices or sounds
    Repetitive or intrusive messaging
    Visual / Cognitive
    Dream-like or visual disturbances
    Unusual thoughts or imagery
    Physical Sensations
    Heat, pressure, or vibration
    Shock-like sensations
    Head or body discomfort
    Sleep / Behavior
    Sleep disruption
    Sudden mood or behavior changes

    4. Patterns or Environment
    Do you notice repeated people, vehicles, or activity?
    Any unusual device behavior or interference?
    Are symptoms stronger at certain locations?

    5. Medical Status
    Have you seen a doctor? (Yes/No)
    Any diagnosis or testing? (brief)
    Current medical conditions (optional)

    6. Safety Check
    Do you feel unsafe? (Yes/No)
    Have you had thoughts of harming yourself or others? (Yes/No)

    7. Evidence & Impact
    Do you have any evidence? (photos, notes, recordings)
    Has this affected your work, school, or daily life?

    8. Additional Details
    Do you believe someone is involved? (optional)
    Have you reported this before? (optional)

    9. Final Statement (Optional)
    Briefly describe your experience in your own words:

    Privacy Notice
    Your information is confidential and will not be shared without your consent.

    Emergency Notice
    If you are in immediate danger, call 911.
    DEW Police is a civilian documentation initiative and not a law enforcement agency.