Pain Support Group Application Form

We are collecting this information to identify ways to improve the support we provide to people living with pain who are engaging with APMA's Pain Support Group program and see how we are helping them over time.

Providing your full name is optional, however, we do ask that you register a legitimate email address. We will not spam you and will only use this information to contact you about pain support group meetings you engaged with and to ask how you are going on your pain management journey twice per year.

We are currently funded by Qld Health. When you tell us you are in a postcode outside of QLD, we will use this information (completely de-identified) to tell policy makers and Government that we need more support from other State & Territory Governments and at a Federal Government level to operate Pain Support Groups.

We ask that all participants using our Pain Support Group program be FREE members of APMA. Becoming a free member provides you with online access to our library of resources.

https://www.painmanagement.org.au/membership

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1. Preferred Name (first name only is fine)
 *
2. The date you are completing this form
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3. Your email address
 *
4. Please note, you must be a member of APMA to join a Pain Support Group. Membership is free for people that live with pain. You can become a member on our website https://www.painmanagement.org.au/membership  *
5. Do you identify with any of these vulnerable communities? *
Required
6. What is your age bracket? *
7. Do you identify as: *
8. What is your postcode? (we ask this to ensure you are linked to the most appropriate group)
 *
9. How long have you attended pain support group meetings?
Clear selection
10. Where and how did you hear about us? *
Required
11. Have you attended a Pain Management Program?
Clear selection
12. Have you seen a Pain Specialist?
Clear selection
13. What is the name of the pain management program you attended / waitlisted for?
The following questions are to understand your personal objectives with being in a support group and how we can best support you.

14. Is loneliness and isolation due to pain an issue for you?
 *
Required
15. Would you like to enhance your pain self management skills? (this can sometimes be called self-efficacy, which is your confidence in the ability to be in control over your own motivation, behaviour, and social environment)
 *
Required
16. Do you have a plan in place for when you experience a pain flare?
*
Required
17. Do you believe you can enjoy life despite the pain?
*
Required
18. Do you have a good team of health professionals, including a GP, supporting you with your pain management?
*
Required
19. What are your objectives for self-managing pain? (e.g. I want to work up to achieving a particular task)
*
20. Do you have any barriers to attending a pain support group meeting each month? (e.g. carer responsibilities, transport, internet access)
*
21. What are your interests?
*
22. Is there anything else you wanted to mention about APMA and our support services?
23. Once or twice a year we'd like to check in with you to see how we can support you better. We'd do this by emailing you or asking the facilitator of your pain support group to check in with you. Is that okay? *
Required
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