*-*-*-*-*-*- Taser-Torture-Victims *-*-*-*-* "The U.S. One Accord Coalition Against Torture" *-*-*-*-*-*-


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Severe Pain + Terror of Death = Super Torture = Cruel + Unusual Punishment.

Our goal is to collect information from a great many of the over 100,000 Taser-Torture-Victims, Victims who were subjected to painful Torture and The Terror of Death from electrocution. Evidence indicates that the use of 50,000 volt Taser Electronic Torture Devices has caused great Physiological, Psychological, Social and Economic harm to many Victims. This submitted form is sorted and the results placed in a data base. The information that you submit will strengthen the fight to have Taser-Torture along with all other Torture use outlawed in the United States of America.

Information about Post Traumatic Stress Syndrome, Depression and Permanent Nerve Damage can be made in follow up emails.

Last Name *

Sex Age (Fields with * must be filled out)

Address

Address two

City State

zip code

Phone *

Email *

We respect your privacy and will only publish the information that you approve.

How long were you Tortured (seconds)

Number of trigger Pulls)

Number of barbs fired into your body

Number of Dry Stuns

Overall health before being Tased:

Overall health after being Tased

Check any of the following complaints that apply to you. Be honest this is a study.

c1 Headaches c2 Seizures c3 Trembling (twitching)

c4 Anxiety Attacks c5 Paranoia c6 Confusion

c7 Heart Problems c8 Memory Loss c9 Inability to Concentrate

c10 Impaired Vision c11 Impaired Hearing c12 Impaired Muscle Control

c13 impaired Kidney Function c14 Digestive problems c15 Impotence

c16 Sleep disturbances c17 Lethargy c18 Night Terrors

c19 Lingering Nerve Pain c20 Muscle Weakness c21 Chipped Teeth

Select where the Taser barbs were embedded.

c22 head front c23 head back c24 head left

c25 head right c26 face left c27 face right

c28 throat center c29 Throat left c30 Throat right

c31 neck back center c32 neck back left c33 neck back right

c34 neck back spine c35neck left c36 neck right

c37 upper back center c38 upper back spine c39 upper back left

c40 upper back right c41 left shoulder front c42 left shoulder back

c43 right shoulder front c44 right shoulder back c45 left biceps

c46 right biceps c47 right wrist c48 left wrist

c49 left hand c50 right hand c51 mid back spine

c52 mid back left c53 mid back right c54 lower back-center

c55 Lower back spine 56 lower back-left c57 lower back right

c58 upper chest center c59 upper chest left c60 upper chest right

c61 mid chest center c62 (heart area) c63 mid chest right

c64 rib cage left c65 rib cage right c66 stomach center

c67 stomach left c68 stomach right c69 lower abdomen center

c70 lower abdomen left c71 lower abdomen right c72 left hip

c73 right hip c74 left buttocks c75 right buttocks

c76 Groin area c77 left thigh front c78 left thigh outside

c79 left thigh inside c80 left thigh back c81 right thigh front

c82 right thigh outside c83 right thigh inside c84 right thigh back

c85 left Knee front c86 left knee outside c87 left knee inside

c88 left knee back c89 right knee front c90 right knee outside

c91 right knee inside c92 right knee back c93 left calf front

c94 left calf outside c95 left calf inside c96 left calf back

c97 right calf front c98 right calf outside c99 right calf inside

c100 right calf back c101 left ankle c102 right ankle

103 left foot top c104 left foot bottom 105 right foot top

c106 right foot bottom

In Memory of Patrick Hagans

age 42 Valleyview, Ohio

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Email: study@taser-torture-victims.com