Question 1 of 14

What is your first name? *

Question 2 of 14

What is your date of birth? *

Question 3 of 14

How often do you have nightmares? *

Every night A few times a week Weekly Occasionally

Question 4 of 14

What is the main theme of your nightmare? *

Being chased Falling Losing teeth Death Being trapped Failure or embarrassment Natural disaster Paranormal or supernatural

Question 5 of 14

What is the source of threat in your nightmare? *

Unknown dark entity Someone I know Monster or creature Force of nature My own fears manifested No clear visible threat

Question 6 of 14

What is the dominant fear in the nightmare? *

Death Abandonment Failure or embarrassment Loss of control Betrayal Physical harm Unknown or shifting place

Question 7 of 14

Can you escape in the nightmare? *

I sometimes escape I never escape I freeze in place I always wake before the outcome

Question 8 of 14

How do you feel immediately after waking from the nightmare? *

Panic attack Sweating profusely Heart racing Crying Calm but uneasy Fine within minutes

Question 9 of 14

When did the nightmares begin? *

After a trauma or loss During periods of high stress No clear trigger Since childhood Started recently

Question 10 of 14

What are your current main life stressors? *

Select all that apply

Relationship Work / Career Finances Health Family Grief or loss Major life change Isolation

Question 11 of 14

How would you rate your overall sleep quality? (1-10) *

Question 12 of 14

Please describe the nightmare in detail *

Question 13 of 14

Did you have nightmares as a child? *

Yes, very similar themes Yes, but different content No I don't remember

Question 14 of 14

How anxious do you feel during the day? (1-10) *

Final Step

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