Dream Interpretation Questionaire and Order Form

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


E-mail Address*
must be exact!



History of Mental Illness?

Recent Physical Illness or Accident?

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.

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

Is this a recurring dream?

How did the dream make you feel?

Describe your day before dream

Describe 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?
If yes, explain

If Dream was indoors, describe lighting
sunlight 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 here

After 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.

Payment information
I accept VISA, MASTERCARD, Discover and American Express.  This is sent over a SECURE server so  all of your information is safe!
If you do not have a credit card simply print out this form and mail it along with your check for 35.00 U.S. dollars to :
Michael Thiessen
7117 John Pitts Road
Panama City, FL 32404

We accept VISA MasterCard AMEX and Discover

We accept VISA, MasterCard, American Express and Discover.
You will be charged 35.00 U.S. dollars only

Select Type

Card Information
Credit Card Number
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)