Pain to Peace Registration
  • Pain to Peace Registration

  • 🌿 Welcome to Pain to Peace

    This form will guide you through registration, informed consent, and payment for the Pain to Peace group. We’ve included this information so you can make a fully informed decision and feel clear and supported before joining.

    You don’t need to rush, take your time, and please reach out if you have any questions before submitting.

  • Participant Information

  • About Pain to Peace Group

  • Pain to Peace is a gentle, supportive 6-week virtual group designed to help you move from frustration and overwhelm toward understanding and relief. Together, we explore strategies that retrain the nervous system, reduce pain perception, and restore a sense of calm and confidence in daily life.

    Through guided exercises, mindfulness practices, and somatic tracking, you’ll learn tools that you can use every day. You’ll also connect with others navigating similar challenges, sharing a safe, confidential space for support and growth.

    This group is for anyone ready to take an active, informed step toward managing chronic pain with compassion, clarity, and practical strategies.


    Day & Time: Thursdays at 12:00 PM
    Start Date: April 2
    Format: Virtual
    Number of Sessions: 6 sessions

    Cost: $300
    Payment is required to reserve your spot in the group.

    A receipt will be provided at the end of the program, which may be submitted to your insurance provider. Please note that insurance coverage varies, and it is your responsibility to confirm eligibility with your insurance company.

    This group is held virtually. Participants are encouraged to join from a private and quiet space to support confidentiality and engagement.

  • Confidentiality Guidelines

  • Your privacy is important to us. The facilitators are bound by professional and ethical standards of confidentiality.

    Because this is a group setting, confidentiality cannot be guaranteed in the same way as in individual therapy. While all participants are expected to respect confidentiality, we cannot control what other group members choose to share outside of the group.

    By participating in this group, you agree to:

    • Respect the privacy and confidentiality of other group members
    • Not share personal or identifying information disclosed by others outside of the group. 
    • Help create a respectful, supportive, and non-judgmental group environment
    • Group confidentiality guidelines will be reviewed again during the first session.
  • Informed Consent for Group Participation

  • By signing below, I acknowledge and agree that:

    • I am voluntarily choosing to participate in the Pain to Peace group.
    • I understand that this group uses a psychoeducational and nervous system-informed, mind-body approach to chronic pain.
    • I understand that participation may bring up emotional or physical sensations, and I am encouraged to listen to my body and participate within my own limits.
    • I understand that I may ask questions, pause participation, or withdraw from the group at any time.
    • I understand the limits of confidentiality, including situations where facilitators may be required to disclose information due to safety concerns or legal obligations.
    • I have read and understood the information above and consent to participate in this group.
  •  - -
  • A little about you

  • prevnext( X )
      Pain to Peace: A 6-week Virtual Chronic Pain Recovery GroupYou’re about to reserve your spot in Pain to Peace. Over six weeks, you’ll be guided through strategies to better understand and manage your pain, practice gentle mindfulness and body awareness, and connect with a supportive group. Your spot is confirmed once payment is completed, and a receipt will be provided for insurance purposes.
      $300.00
        
      Total
      $0.00

      Credit Card Details
    • Should be Empty: