Pain Management Application Form

Thank you for your interest in 1:1 pain management coaching.

This personalised coaching is designed for those ready to take a holistic approach to managing pain, reconnecting with their bodies, and creating lasting change. Please take your time answering these questions so we can ensure this coaching is the right fit for you.

Name

First Name

Last Name

Where in the world are you located?

Phone

(###)

###

####

Your Pain Journey

How long have you been living with chronic pain? When did it start, and do you have any known diagnoses?

How does chronic pain impact your daily life? What limitations, struggles, or emotional challenges do you face because of pain?

What treatments or approaches have you tried so far? Have you worked with practitioners, tried medication, therapy, or natural approaches? What has or hasn’t worked for you?

What’s one thing you WISH was different about your life with pain? If you could change just one thing, what would it be?

Support & Readiness

What is currently helping you cope with pain? Are there any practices, people, or routines that support you?

If fear or doubt weren’t a factor, what kind of life would you create for yourself? How would you feel? What would you be able to do that pain currently limits?

Why do you want to commit to this healing journey NOW? What is the cost of staying stuck? Why is this the right time for you to make a change?

What is your support system like? Do you have family, friends, or a community supporting your healing? Do you ask for help when you need it?

Commitment & Accountability

This course utilises a holistic, evidence-based, and mind-body approach to pain management. It is designed to empower you with the tools to navigate pain in a new way. However, real transformation requires your commitment and active participation. Are you ready to take responsibility for your healing journey?

YES! I understand that no one can do this for me, and I’m ready to commit to the work.

No, I prefer a more guided approach and may not be ready to take full accountability.

Are you in a position to invest in yourself and commit to your healing?

YES, I fully understand that investing in myself is the best decision I can make. I’m all in!

YES, but I’d like to explore a payment plan option.

No, I’m not in a position to invest right now, but I’d love to join a future round.

Pain Management Application Form

beth lee naturopath

bethleenaturopath@gmail.com