Please fill out the form below as completely as possible. The more details I have, the more likely it is that the interpretation I do for you will be accurate! Once you have completed the form and hit the submit button at the bottom, it will be sent to me via my secure server. I will do my best to get this done for you as fast as possible. It takes anywhere from one day to one week depending on the amount of dreams I have to analyze. A * next to a question indicates it is REQUIRED in order to submit form. note: Leaving questions with Not given will LOWER the accuracy of the interpretation!
A few questions about you...Strictly for dream interpretation reasons
Name*E-mail Address* must be exact!
Age 10 - 15 years of age 16 - 18 years of age 18 - 25 years of age 26 - 35 years of age 36 - 45 years of age 46 - 55 years of age 56 or above Not given Sex Male Female Not given
History of Mental Illness? Yes No Not given
Recent Physical Illness or Accident? Not given Yes No
If you answered Yes to either question above, please explain
Any recent or upcoming dramatic emotional upset in your life?This can be a death of someone close or even a pet. Things like divorce, break-ups, bankruptcy or ANYTHING that effects you emotionally in a profound way, EVEN good things like a new job or house. Yes No Not given
If you answered Yes above, please explain
Questions about your dream...Use your notes from your dream journal if you keep one
Define what you feel is the “Type” of dream Nightmare Normal dream Prophetic Dream Spirtual Dream - attempting to disclose some spirtual understanding or wisdom Physical Dream - Dream is attempting to warn you of illness or injury. Erotic Dream - dream of a sexual nature
Is this a recurring dream? Yes No Not given How did the dream make you feel? Not given Joyful Creative Excited Empowered Fearful Frustrated Anxious Powerless Sad Angry Lonely Destructive Describe your day before dreamDescribe the weather in the dream(cloudly, overcast, changing from sunny to cloudy)
If yes, how long have you been having dream? Anyone else you know having same type of dream? Not given Yes No If yes, explain If Dream was indoors, describe lightingsunlight through window, bare light bulb, fancy lighting, etc. Give overall mood.
Tell Me Your Dream*The most important part of this questionnaire. Do not leave out any details. Give this careful consideration, do not embellish or attempt to fill in gaps. Dreams commonly do not make logical sense, so you won’t seem “crazy” to me if your dream has holes in it. DETAIL is the most important part! You cannot give me too much information!If any of the dream symbols in this dream have a SPECIAL meaning to you, please list them hereAfter I receive this information I will get started on interpreting this dream right away. I will email you with my findings ASAP.I will correspond with you concerning this dream as many times as it takes within reason to help you get a clear picture of what it means. Within reason is defined by a maximum of 4 exchanges. Correspondence is only for the original dream I am interpreting for you.
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We accept VISA, MasterCard, American Express and Discover.You will be charged 35.00 U.S. dollars only
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Card Information Credit Card Number Month January 01 February 02 March 03 April 04 May 05 June 06 July 07 August 08 September 09 October 10 November 11 December 12 Year 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Expiration Date Person's Name on Card(exact spelling please)
Address of cardholder
(note: Must be the same address that the credit card bill is sent to, if different explain below)
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