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I have chronic pain and am between the ages of 12 and 25.
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Email
*
Your email
How old are you? (in years)
*
Your answer
What is your gender?
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Female
Male
Prefer not to say
Other:
What state do you live in?
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Your answer
What kind of chronic pain are you experiencing?
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Abdominal Pain
Ankylosing Spondylitis
Back Pain
Central Pain Syndrome
Complex Regional Pain Syndrome (CRPS)
Fatigue
Headaches
Menstrual Pains
Postural Orthostatic Tachycardia (POTS)
Sleep Issues
Sports Injuries
Arthritis
Autoimmune Diseases
Cancer Pain
Chronic Fatigue Syndrome
Crohn’s Disease
Fibromyalgia
Irritable Bowel Syndrome (IBS)
Musculoskeletal Pain
Rheumatoid Arthritis
Sickle Cell Disease
Other:
Required
What are some pain related issues that you are currently facing?
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Feeling isolated and/or alone
Feeling confused
Feeling overwhelmed
Feeling misunderstood by family
Missing school
Poor sleep
Struggling due to financial reasons
Not understanding chronic pain myself
Feeling scared
Feeling frustrated
Feeling misunderstood by doctors
Feeling misunderstood by friends
Missing sports or other extracurricular activities
Experiencing mental health issues (like depression or anxiety)
Struggling due to where I live
Other:
Required
Which creative healing technique(s) are you interested in learning more about?
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Acupuncture/acupressure
Aromatherapy
Art
Art Therapy
Biofeedback
Cartooning/Animation
Cooking
Crafting
Culinary Therapy
Dance
Dance Therapy
Gardening
Guided Exercise Programs
Hypnotherapy/Guided Imagery
Massage/Craniosacral Techniques
Mind-based Techniques
Mindfulness/Meditation
Movies/Filmmaking
Music
Music Therapy
Pet/Animal-Assisted Therapy
Photography
Theater/Performance Arts
Volunteering
Writing/Poetry
Writing Therapy
Yoga
Other:
Required
Would you be interested in joining CHYP to explore creative healing techniques and interact with other teens who have chronic pain?
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Yes
No
Maybe
Are you interested in getting updates about CHYP’s development and services?
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Yes
No
Maybe
Is there anything else you would like to tell us?
Your answer
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