Intake form

Name *

Email address *

What chronic pain conditions do you experience?

Please select at least one option.

Arthritis

Fibromyalgia

Back pain

Migraines

Neuropathy

Other chronic pain conditions

How long have you been experiencing chronic pain?

What treatments or therapies have you tried?

How does your chronic pain affect your daily life?

What are your goals for life coaching?

Have you previously worked with a life coach?

What are your preferred methods of communication?

Please select at least one option.

Email

Phone

Video Call

In-person

Are there specific topics you wish to focus on during coaching sessions?

What is your age group?

How did you hear about live love through pain?

Which service or services are you interested in?

Please select at least one option.

Empowerment coaching

Mindfulness practices

A safe space for you

Additional questions or comments

Live Love Through Pain