* Where is your chronic pain located?

* How long have you had your pain?

* If you got a diagnosis, what was it and describe your experience with the doctor at that time? (How did they tell you, how did it make you feel, do you feel hopeful for any pain relief in the future based upon the diagnosis)

* What aspects of your life does your pain affect? Mark all that apply.

* How would your life be different from today if you didn't have your pain? Be specific as possible. 

* Anything else you want to add about your specific pain/condition that you either haven't mentioned before (like to a doctor for fear of ridicule or lack of listening to you) or you feel that your pain is different and you would like to share. (There's no right or wrong or judged answer here, so please share, everything you say is helpful and I'm thankful to you for it.)

* THANK YOU!!! Your feedback is much appreciated and you are helping by directly being a part of a "pain-relief for good" program designed specifically for women. If you would like to be notified of the initial program to test it out, please leave your email below, otherwise, thank you again for your feedback. You have been generous and I pray for lasting relief and peace for you. 
Again, your email is not required, only if you want to participate or get information on the upcoming design and first look at the "pain-relief for good" program (official name not picked yet!).

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