Dreams Survey - Dreams about health
A survey about the relationship between physical health and dreams
Name
Name to use in our presentations
Your gender
Male
Female
Marital status
Single
Married
Widow
In a relationship
E-mail
(if you want to be emailed the results)
What country do you live in?
Do you consider yourself to be a perfectionist?
1
2
3
4
5
Not at All
Very Much Part of My Life
1 is Not at All, 5 is Very Much Part of My Life
Your birth was
natural
caesarean
I don't know
Were you raised in a religious family?
yes
no
How important is religion or spirituality to you?
1
2
3
4
5
Not at All
Very Much Part of My Life
1 is Not at All, 5 is Very Much Part of My Life
What is your working situation?
working: please answer next question
looking for a job
retired
taking care of my home
Are you happy wih your job?
yes
no
I am not sure
When did dream occur?
Prior to illness
During illness
After recovery
Did you dream about your own health?
yes
no about somebody I know: please also answer next question
Who did the dream refer to? For example: brother, sister, friend...
What kind of disease does the dream refer to?
Dream Title
Dream Text
Dream Text only. You will have an opportunity to share comments/notes after
Your Comments About the Dream
Emotions/feelings after dream
I felt better
I felt worse
There was no change in feeling
How did you act on the dream?
I did not act on it
It got me to see a docter
It got me to change docters
It got me to talk about my dream with others
Other:
(please specify anything not mentioned above separated by commas)
Photo or Artwork regarding dream
can be the loved one's photo or a drawing you've done that we can use in the presenatation
Agreement/Release:
I agree to allow my dream, images I've provided and statistics to be used for a presentation and/or other materials for print, book or web to be used for your research results. If any name is given its only that which you indicate you would like used at the top of survey, however, we mostly will use just initials.
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