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The Only
Dream / Cancer Survey
on the Internet

This is the only Dream/Cancer Survey on the Internet that lets you express the connection between your dreams and cancer.   You may also e-mail your dreams to me.  

Name

1. Do you view dreams as: (You can select multiple responses.)

Subconscious Yes No
ESP Yes No
Foretelling the Future Yes No
A way of dealing with Reality Yes No

2. Do you:

Write down your dreams. Yes No
Remember your dreams. Yes No
Discuss your dreams with others. Yes No

3. What kind of cancer is involved?  How many times have you had cancer?  When?

4. What kind of treatment? (You can select multiple responses.)

Chemotherapy Yes No
Surgery Yes No
Radiation Yes No
Psychotherapy Yes No
Hypnotherapy Yes No
Counseling Yes No
Support Group/Friends Yes No
Religious Belief Yes No
Yourself Yes No
Other:

5. Do you or did you use dreams and/or imaging as treatment to deal with cancer or stress?

Yes No

6. If the answer to the above question is YES, then what symbols were used?

7. Please answer the next few questions to let me have a feel for who is answering the survey.

A. Are you Female or Male ?

B. What is your age?

13-19 20-29 30-39 40-49 50+

C. What is your occupation?

D. Where do you live?

8. Have your dreams changed since having cancer? Yes No

9. Have you, the dreamer, changed in your waking life? Yes No

10. If Yes, how has your life changed?

Your Career Improved Worsened No Change
Your Self-image Improved Worsened No Change
Relationships/friends Improved Worsened No Change
Spiritual conceptions Improved Worsened No Change
Your reactions to Life Improved Worsened No Change
Familial Relations:
Spouse/Significant Other Improved Worsened No Change
Parent Improved Worsened No Change
Children Improved Worsened No Change
Siblings Improved Worsened No Change

11. As a result of discussing, remembering and/or writing down your dreams:

A. Are you better able to cope while you are dreaming? Yes No
B. Are you better able to cope with stress and problems when awake? Yes No
C. Do you feel more connected to people when you are awake? Yes No
D. Have you changed the way you react to Life when awake? Yes No

12. In your dreams, are you:

13. If you have recurring dreams, please describe them.

14. Do you have advice or thoughts to help others trying to cope with cancer?

Contact Information (completely optional)

Name
Address
City/State/Zip
URL
FAX
E-mail 
 

Copyright © 1997-8 [Diana DeMille]. All rights reserved.
Revised: October 12, 2002.