Request Your Consult

If you're exploring the Pain Relief & Renewal Therapy Intensive, you're already carrying so much. I am here to guide you so that you don’t have to do it alone.This short form will help me understand what you’re experiencing and what you’re hoping for so we can decide together whether this intensive is the right next step for you. Please take a moment to answer these questions gently and honestly. There’s no right or wrong answer.

This form is for requesting a brief consult for the Pain Relief & Renewal Therapy Intensive. Please do not include sensitive medical details. Submitting this form does not create a therapist–client relationship. Your information will be kept private and handled in accordance with HIPAA guidelines.

First Name *

Phone *

Email *

Preferred Contact Method: *

What feels most difficult about living with pain right now? *

How is pain affecting your daily life, routines, or the way you show up for yourself and others? *

If even a small shift in relief became possible, what would you hope to feel in your body or in your life? *

Location for Services: Therapy services must take place while you are physically in Florida (virtual or in-person). The Intensive can be completed either as a resident or by traveling to Florida during the sessions. *

I understand and agree to submit this information for the purpose of scheduling a consult. I give Path For Change permission to contact me using my preferred method to schedule a consult for this Intensive.

By checking this box, I consent to receive communication by email, text, or phone from Path For Change.