Dream Intake Form

Please submit your responses before our time together.

Name

First Name

Last Name

Birth day, time & location

If you don't know your exact time, include what you do know. :)

Caffeine, Alcohol, Cannabis, Tobacco, Other Substance Consumption? If so, how often?

How many hours per night do you sleep? Is it straight through or do you wake in the night? If so, how many times and approximately at what times?

What is your sleep routine like? What time do you go to bed and what time do you get up? How long does it take you to wind down? Do you have any before-bed rituals? Morning rituals?

How often do you recall your dreams?

Have you experienced a lucid dream before? (a sense of knowing in the dream that you are, in fact, dreaming, sometimes but not always accompanied by the ability to control the dream or shift what is happening.) If so, how often?

Do you have any recurring dreams, patterns or themes? At what age did you first remember the recurrence beginning?

What do you enjoy most to express yourself? (i.e. painting, writing, singing, dancing, etc.)

How do you nourish yourself? (physical, mental, emotional & spiritual)

Where might you feel most challenged or stuck?

What are you ready to let go of?

Where do you wish to see yourself in 6 months and/or how do you wish to feel?

What are you calling in and/or what is your highest dream?