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Thank you for your interest in this masterclass.
Step 1: Tell us a little about your situation.
Step 2: Schedule your 10-minute call with our team.
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Email
*
Your email
Name
*
First name
Your answer
Do you identify as Black, Indigenous, and Person of Color (BIPOC)
*
Yes
No
Date of Birth (Month/Day/Year) for the pre and post-assessment
MM
/
DD
/
YYYY
Last Name
*
Your answer
Phone number
*
Your answer
What is your diagnosed condition(s), prominent symptoms, and how long have you had them?
*
Your answer
Where are you in your journey to managing your condition?
*
I have no idea how to manage my condition.
I can manage my condition less than 25% of the time.
I can manage my condition 20-50% of the time.
I can manage my condition 50-75% of the time
Other:
What is the average intensity of your pain on a scale from 1-10 (1 being the least and 10 being the most)?
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1
2
3
4
5
6
7
8
9
10
What would your goal be in joining a group or individual coaching about healing chronic pain?
*
Reduce the impact of my pain on my daily life (work, family, relationships, etc)
Reduce my medication by 50% or more.
Find a way to cope with the pain.
Find a way to reverse my condition.
I'm not sure healing is possible.
Other:
Required
Overall, what is your greatest challenge with managing your chronic condition?
*
Your answer
What would it mean to you to have consistent relief or a reduction in symptoms? What would you do with the new you?
*
Your answer
What type of phone do you use?
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Iphone
Android
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