Share Your Story

Your Email *

How old are you? (in years) *

What is your gender? *

What state do you live in? *

If other, please explain below:

What kind of chronic pain are you experiencing? (choose all that apply) *

If other, please explain below:

What are some pain related issues that you are currently facing? (choose all that apply) *

If other, please explain below:

Which creative healing technique(s) are you interested in learning more about? (choose all that apply) *

If other, please explain below:

Would you be interested in joining chyp to explore creative healing techniques and interact with other teens who have chronic pain? *

Are you interested in getting updates about chyp’s development and services? *

Is there anything else you would like to tell us?