Original Assessment Sheet Oas (NED-05R)

RelationDate of DeathE-Meter ReactionRelationDate of DeathE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

8. Where and with whom do you live? _______________________ E-Meter Reaction _______________

9. Are you currently associated with anyone who is antagonistic to mental or spiritual treatment or Scientology?

(If yes, who?):E-Meter Reaction(If yes, who?):E-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

On questions 10 through 17 if the answer is “yes” find out who and E-Meter reaction.

10. Is anyone actively objecting to your getting treatment? _______________________

11. Has anyone insisted you get treatment? _______________________

12. Has anyone ever objected to your getting treatment? _______________________

13. Has anyone encouraged you to get treatment? _______________________

14. Has anyone ever objected to you getting better? _______________________

15. Has anyone ever assisted you in self-betterment? _______________________

16. Does anyone not like you the way you are? _______________________

17. Has anyone tried to make you change or be different? _______________________

B. MARITAL STATUS:

1. Married ______ Single ______ No. of times Divorced ________________ E-Meter Reaction __________

2. Pc’s statement of relationship with spouse: _______________________ E-Meter Reaction __________

3. List any marital difficulties pc presently has: _______________________ E-Meter Reaction __________

4. If divorced, list reasons for divorce and pc’s emotional feeling about divorce: _______________________ E-Meter Reaction __________

5. List children, date of death of any child and E-Meter reaction:

ChildrenDate of DeathE-Meter ReactionChildrenDate of DeathE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

C. EDUCATION LEVEL:

State the level of schooling pc has had, university education, or professional training: _____________________ E-Meter Reaction ___________

D. PROFESSIONAL LIFE:

State main jobs pc has held:

JobE-Meter ReactionJobE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

E. DRUGS:

(NOTE: LIST DRUGS, MEDICINE OR ALCOHOL TAKEN THIS LIFETIME ONLY.)

1. Are you taking any drugs currently?

What DrugDate (How Long)E-Meter ReactionWhat DrugDate (How Long)E-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Have you ever taken drugs?

What DrugDateE-Meter ReactionWhat DrugDateE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

2. Are you taking any alcohol or alcoholic drink currently?

What Alcohol/Alcoholic DrinkDate (How Long)E-Meter ReactionWhat Alcohol/Alcoholic DrinkDate (How Long)E-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Have you ever taken alcohol or alcoholic drinks?

What Alcohol/Alcoholic DrinkDateE-Meter ReactionWhat Alcohol/Alcoholic DrinkDateE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

3. List any medicine currently or previously taken.

WhatWhen (How Long)E-Meter ReactionWhatWhen (How Long)E-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

F. LOSSES:

What severe losses have you had in life that influenced it?

LossDateDescriptionE-Meter ReactionLossDateDescriptionE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

G. DEATHS:

What deaths have severely affected your life?

DeathDateDescriptionE-Meter ReactionDeathDateDescriptionE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

H. UPSETS:

Are you upset with or cross about anything or anyone at this particular time?

UpsetDateDescriptionE-Meter ReactionUpsetDateDescriptionE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

I. DANGERS:

1. Are you in any particular danger at this time?

DescriptionE-Meter ReactionDescriptionE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

2. Are there engrams that match this in the past?

(Note meter read.) ____________________

J. ACCIDENTS:

List any serious accidents pc has had, the date of such, any permanent physical damage, and E-Meter reaction.

AccidentDatePhysical DamageE-Meter ReactionAccidentDatePhysical DamageE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

K. ILLNESSES:

List any serious illness pc has had giving date of each, any permanent-physical damage, and E-Meter reaction.

IllnessDatePhysical DamageE-Meter ReactionIllnessDatePhysical DamageE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

L. OPERATIONS:

List any operation, the date of each and E-Meter reaction.

OperationDateE-Meter ReactionOperationDateE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

M. PRESENT PHYSICAL CONDITION:

List any bad physical condition pc presently has and E-Meter reaction to such.

Physical ConditionE-Meter ReactionPhysical ConditionE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

N. PT ILLNESSES:

1. List any illnesses the pc currently has.

IllnessDateE-Meter ReactionIllnessDateE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

2. Do you have any recurring physical ailment? _____________ E-Meter Reaction _________

O. DISABILITY PAYMENT OR PENSION:

List any disability payment or pension received by the pc, what it is for, how much and for how long it has been received.

What ForHow MuchDurationE-Meter ReactionWhat ForHow MuchDurationE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

P. ANY FAMILY HISTORY OF INSANITY:

WhoWhatWhenE-Meter ReactionWhoWhatWhenE-Meter Reaction ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________

Q. EYES: E-Meter Reaction

Реакция Е-метраРеакция Е-метра Any tint in eye white___________________________________Any tint in eye white___________________________________ Eye Color___________________________________Eye Color___________________________________ Color Blindness___________________________________Color Blindness___________________________________ Glasses___________________________________Glasses___________________________________

R. BODY WEIGHT:

Реакция Е-метраРеакция Е-метра Overweight?____________________________________Overweight?____________________________________ Underweight?____________________________________Underweight?____________________________________

S. ANY PERCEPTION DIFFICULTIES:

WhatE-Meter ReactionWhatE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

T. ANY PERCEPTION TROUBLE IN FAMILY:

U. SICK OR DISABLED FAMILY:

V. EARLIER ALLIES OR CLOSE FRIENDS:

W. HUSBAND OR WIFE PHYSICAL TROUBLES:

X. ATTITUDE TOWARDS ILLNESS:

Y. ATTITUDE TOWARDS TREATMENT:

Z. ANY CURRENT TREATMENT IN PROGRESS:

AA. COMPULSIONS, REPRESSIONS AND FEARS:

List any compulsions (things pc feels compelled to do), repressions (things pc must prevent himself from doing) and any fears of pc.

Compulsions:E-Meter ReactionCompulsions:E-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Repressions:E-Meter ReactionRepressions:E-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Fears:E-Meter ReactionFears:E-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

Are you trying to change something someone else doesn’t like?

What and WhoE-Meter ReactionWhat and WhoE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________

BB. CRIMINAL RECORD:

List any crime committed by pc, prison sentence, if any.

CrimeSentenceE-Meter ReactionCrimeSentenceE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

CC. INTERESTS AND HOBBIES:

List any interests and hobbies of pc.

Interests and HobbiesE-Meter ReactionInterests and HobbiesE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

DD. ARE YOU HERE ON YOUR OWN SELF-DETERMINISM?

_________________________E-Meter Reaction ______________________________________E-Meter Reaction _____________

EE. PREVIOUS DIANETIC OR SCIENTOLOGY PROCESSING:

1. List auditors, hours, and E-Meter reaction to any processing done.

AuditorHoursE-Meter ReactionAuditorHoursE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

2. List briefly processes run:

__________________________________________________ __________________________________________________ __________________________________________________

3. List goals attained from such processing:

4. List goals not attained from such processing:

E-Meter ReactionE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________

FF.

1. Do you look on yourself as somebody else?

2. When you see pictures of the past do you see yourself from a distance?

GG. FORMER PRACTICES:

1. What practices or treatments have you engaged upon in the past?

Practice or TherapyDateE-Meter ReactionPractice or TherapyDateE-Meter Reaction __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

2. Are you continuing any of the above in the present?

__________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

HH. What problems are you trying to solve by processing?

E-Meter ReactionE-Meter Reaction ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________

II. Have you ever done anything harmful to Dianetics, Dianeticists, Scientology, Scientologists or organizations?

JJ. REALITY FACTOR:

You know of course that people sometimes get cross at the auditor or run away when they are withholding information from them and we don’t want you to do that.

Anything you tell me is confidential and is protected under ministerial confidence.

Is there anything we have missed or omitted while doing this assessment? (Carefully note any meter reads.)

Ask: “Is there anything you would care to tell me about this?”

State of needle at the end of the above _________________

L. RON HUBBARD
Founder

LRH:ldv.dr

HUBBARD COMMUNICATIONS OFFICE Saint Hill Manor, East Grinstead, Sussex HCO BULLETIN OF 24 JUNE 1978R REVISED 22 SEPTEMBER 1978 (Cancels BTB 24 Apr 69RA, Preclear Assessment Sheet)	HUBBARD COMMUNICATIONS OFFICE Saint Hill Manor, East Grinstead, Sussex HCO BULLETIN OF 24 JUNE 1978R REVISED 22 SEPTEMBER 1978 (Cancels BTB 24 Apr 69RA, Preclear Assessment Sheet)
Remimeo	Remimeo
BPI	BPI
HGC	HGC
All Auditors	All Auditors
(Revisions in this type style)	(Revisions in this type style)
New Era Dianetics Series 5R	New Era Dianetics Series 5R
ORIGINAL ASSESSMENT SHEET	ORIGINAL ASSESSMENT SHEET
WHEN IS THE ORIGINAL ASSESSMENT SHEET DONE	WHEN IS THE ORIGINAL ASSESSMENT SHEET DONE
This Original Assessment Sheet is done as the beginning action of Dianetics. It is done in a formal Dianetic auditing session in an auditing room with the pc duly signed up, and in session.	This Original Assessment Sheet is done as the beginning action of Dianetics. It is done in a formal Dianetic auditing session in an auditing room with the pc duly signed up, and in session.
WHO DOES THE ORIGINAL ASSESSMENT SHEET	WHO DOES THE ORIGINAL ASSESSMENT SHEET
The auditor assigned to audit the preclear does the assessment. It is included as part of the preclear’s auditing time as it is valuable data collection on the preclear’s case, done with the preclear on the meter.	The auditor assigned to audit the preclear does the assessment. It is included as part of the preclear’s auditing time as it is valuable data collection on the preclear’s case, done with the preclear on the meter.
PURPOSE OF ORIGINAL ASSESSMENT SHEET	PURPOSE OF ORIGINAL ASSESSMENT SHEET
The purpose of this form is to provide essential data regarding the preclear to the C/S, the D of P and the auditor, and to better acquaint the auditor with the preclear at the onset of auditing.	The purpose of this form is to provide essential data regarding the preclear to the C/S, the D of P and the auditor, and to better acquaint the auditor with the preclear at the onset of auditing.
HOW IS THE ORIGINAL ASSESSMENT SHEET DONE	HOW IS THE ORIGINAL ASSESSMENT SHEET DONE
The assessment is done with the preclear on the meter.	The assessment is done with the preclear on the meter.
The preclear is given the R-Factor that you will simply be asking him for essential data about himself for the purpose given above.	The preclear is given the R-Factor that you will simply be asking him for essential data about himself for the purpose given above.
The auditor notes down the data as the pc gives it. He does not take up the pc’s answers to the questions, except, when necessary, to make sure the question is answered and the auditor has the facts straight. TA at start and end of the assessment is noted, along with any TA action during the assessment. Needle reactions to the questions are noted when the question is given plus any needle reaction that occurs during the pc’s reply.	The auditor notes down the data as the pc gives it. He does not take up the pc’s answers to the questions, except, when necessary, to make sure the question is answered and the auditor has the facts straight. TA at start and end of the assessment is noted, along with any TA action during the assessment. Needle reactions to the questions are noted when the question is given plus any needle reaction that occurs during the pc’s reply.
NEATNESS OF ORIGINAL ASSESSMENT SHEET	NEATNESS OF ORIGINAL ASSESSMENT SHEET
The data should be written plainly and neatly on the assessment sheet so that it is readable, as the information is wanted. Auditor does not delay or hold up the pc giving answers, however, while he completes admin.	The data should be written plainly and neatly on the assessment sheet so that it is readable, as the information is wanted. Auditor does not delay or hold up the pc giving answers, however, while he completes admin.
WHERE DOES THE ORIGINAL ASSESSMENT SHEET GO WHEN COMPLETED	WHERE DOES THE ORIGINAL ASSESSMENT SHEET GO WHEN COMPLETED
When completed, the Original Assessment Sheet is kept in the preclear’s folder. A note is made on the Summary Sheet of pc’s folder that the Original Assessment Sheet has been done.	When completed, the Original Assessment Sheet is kept in the preclear’s folder. A note is made on the Summary Sheet of pc’s folder that the Original Assessment Sheet has been done.
ORIGINAL ASSESSMENT SHEET	ORIGINAL ASSESSMENT SHEET

Name of pc: ________	Age of pc: ________

Name of pc: ________	Age of pc: ________

Auditor: ________	Org: ________