{"id":18864,"date":"2022-04-21T01:56:21","date_gmt":"2022-04-21T01:56:21","guid":{"rendered":"https:\/\/brainchanger.io\/?page_id=18864"},"modified":"2022-10-17T22:24:53","modified_gmt":"2022-10-17T22:24:53","slug":"brain-changer-web-eoi","status":"publish","type":"page","link":"https:\/\/brainchanger.io\/brain-changer-web-eoi\/","title":{"rendered":"Brain Changer Web EOI"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"18864\" class=\"elementor elementor-18864\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5fbe76c elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"5fbe76c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0f54114\" data-id=\"0f54114\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4825a34 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4825a34\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fa30050\" data-id=\"fa30050\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-820a64c elementor-widget elementor-widget-html\" data-id=\"820a64c\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"py-3\"><div class=\"ace-h2 ace-primary\" style=\"margin-left: 18px; padding-top: 10px;\">\r\n                Brain Changer BOOST Recovery Program<br> Expression of Interest\r\n              <\/div>\r\n<div style=\"margin-left: 18px; margin-right: 18px; margin-top:20px; margin-bottom: -20px;\r\n\"><p style=\"font-size: 18px; font-weight: 300;\">This form will give the Brain Changer team some background information on how you understand and live with pain at the moment. We will use this information to contact you and tailor the consultation to explore how our program can best meet your needs. This form will take around 2 minutes to complete.<br><br><\/p><\/div>\r\n\r\n<div class=\"ace-bg-yellow\" style=\" padding: 18px; margin-top: 10px; border-radius: 25px; font-family: \"Rubik\";><span style=\"font-weight:600\">The BOOST Recovery program involves extensive contact with a specialist health care professional and the cost will not be covered by Medicare. Private Health Insurance typically does not cover pain programs either. Our company and others are lobbying for changes to the system so that pain care is accessible for everyone.<\/span><\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5aa005f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5aa005f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-888987e\" data-id=\"888987e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bf0f5bb elementor-widget elementor-widget-wpforms\" data-id=\"bf0f5bb\" data-element_type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-18850\"><form id=\"wpforms-form-18850\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"18850\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/wp-json\/wp\/v2\/pages\/18864\/\" data-token=\"4bb42ad1f57d52b1ca75105f2ca2cca8\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-18850-field_48-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"48\"><div id=\"wpforms-18850-field_48\"><div class=\"py-3\" style=\"border-top: 2px solid #f07561; margin-bottom: -20px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_3-container\" class=\"wpforms-field wpforms-field-text ace-h3\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_3\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-18850-field_3\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][3]\" required><\/div><div id=\"wpforms-18850-field_4-container\" class=\"wpforms-field wpforms-field-email ace-h3\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_4\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-18850-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" required><\/div><div id=\"wpforms-18850-field_51-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_51\">Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-18850-field_51\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][51]\" required><\/div><div id=\"wpforms-18850-field_5-container\" class=\"wpforms-field wpforms-field-text ace-h3\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_5\">Location: state or territory if in Australia or if you live elsewhere please tell us which country (incl. city or state), so we know which time zone you&#039;re in. <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-18850-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" required><\/div><div id=\"wpforms-18850-field_34-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"34\"><div id=\"wpforms-18850-field_34\"><div class=\"py-3\" style=\"border-top: 2px solid #f07561; margin-top: 30px; margin-bottom: -20px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_14-container\" class=\"wpforms-field wpforms-field-divider ace-h2\" data-field-id=\"14\"><h3 id=\"wpforms-18850-field_14\" name=\"wpforms[fields][14]\">Living Well with Pain Questionnaire<\/h3><div class=\"wpforms-field-description\">Below you will find a list of statements. Please rate the truth of each statement as it\r\napplies to you.<\/div><\/div><div id=\"wpforms-18850-field_35-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"35\"><div id=\"wpforms-18850-field_35\"><div style=\"margin-bottom: 10px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_7-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_7\">1. I am getting on with the business of living no matter what my level of pain is.<\/label><ul id=\"wpforms-18850-field_7\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_7\" name=\"wpforms[fields][7]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_1\" name=\"wpforms[fields][7]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_2\" name=\"wpforms[fields][7]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_3\" name=\"wpforms[fields][7]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_4\" name=\"wpforms[fields][7]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_5\" name=\"wpforms[fields][7]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_7_6\" name=\"wpforms[fields][7]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_7_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_10-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_10\">2. Keeping my pain level under control takes first priority whenever I\u2019m doing something.<\/label><ul id=\"wpforms-18850-field_10\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_7\" name=\"wpforms[fields][10]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_1\" name=\"wpforms[fields][10]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_2\" name=\"wpforms[fields][10]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_3\" name=\"wpforms[fields][10]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_4\" name=\"wpforms[fields][10]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_5\" name=\"wpforms[fields][10]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_10_6\" name=\"wpforms[fields][10]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_10_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_11-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_11\">3. Although things have changed, I am living a normal life despite my chronic pain.<\/label><ul id=\"wpforms-18850-field_11\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_7\" name=\"wpforms[fields][11]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_1\" name=\"wpforms[fields][11]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_2\" name=\"wpforms[fields][11]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_3\" name=\"wpforms[fields][11]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_4\" name=\"wpforms[fields][11]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_5\" name=\"wpforms[fields][11]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_11_6\" name=\"wpforms[fields][11]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_11_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_12-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_12\">4. Before I can make any serious plans, I have to get some control over my pain.<\/label><ul id=\"wpforms-18850-field_12\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_7\" name=\"wpforms[fields][12]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_1\" name=\"wpforms[fields][12]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_2\" name=\"wpforms[fields][12]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_3\" name=\"wpforms[fields][12]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_4\" name=\"wpforms[fields][12]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_5\" name=\"wpforms[fields][12]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_12_6\" name=\"wpforms[fields][12]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_12_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_15-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_15\">5. I lead a full life even though I have chronic pain.<\/label><ul id=\"wpforms-18850-field_15\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_7\" name=\"wpforms[fields][15]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_1\" name=\"wpforms[fields][15]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_2\" name=\"wpforms[fields][15]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_3\" name=\"wpforms[fields][15]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_4\" name=\"wpforms[fields][15]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_5\" name=\"wpforms[fields][15]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_15_6\" name=\"wpforms[fields][15]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_15_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_16-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_16\">6. When my pain increases, I can still take care of my responsibilities.<\/label><ul id=\"wpforms-18850-field_16\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_7\" name=\"wpforms[fields][16]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_1\" name=\"wpforms[fields][16]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_2\" name=\"wpforms[fields][16]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_3\" name=\"wpforms[fields][16]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_4\" name=\"wpforms[fields][16]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_5\" name=\"wpforms[fields][16]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_16_6\" name=\"wpforms[fields][16]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_16_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_17-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_17\">7. I avoid putting myself in situations where my pain might increase.<\/label><ul id=\"wpforms-18850-field_17\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_7\" name=\"wpforms[fields][17]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_1\" name=\"wpforms[fields][17]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_2\" name=\"wpforms[fields][17]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_3\" name=\"wpforms[fields][17]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_4\" name=\"wpforms[fields][17]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_5\" name=\"wpforms[fields][17]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_17_6\" name=\"wpforms[fields][17]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_17_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_18-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_18\">8. My worries and fears about what pain will do to me are true.<\/label><ul id=\"wpforms-18850-field_18\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_7\" name=\"wpforms[fields][18]\" value=\"0 (Never true)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_7\">0 (Never true)<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_1\" name=\"wpforms[fields][18]\" value=\"1 (Very Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_1\">1 (Very Rarely True)<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_2\" name=\"wpforms[fields][18]\" value=\"2 (Rarely True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_2\">2 (Rarely True)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_3\" name=\"wpforms[fields][18]\" value=\"3 (Sometimes True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_3\">3 (Sometimes True)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_4\" name=\"wpforms[fields][18]\" value=\"4 (Often True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_4\">4 (Often True)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_5\" name=\"wpforms[fields][18]\" value=\"5 (Almost Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_5\">5 (Almost Always True)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_18_6\" name=\"wpforms[fields][18]\" value=\"6 (Always True)\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_18_6\">6 (Always True)<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_31-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"31\"><div id=\"wpforms-18850-field_31\"><div class=\"py-3\" style=\"border-top: 2px solid #f07561; margin-top: 30px; margin-bottom: -20px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_19-container\" class=\"wpforms-field wpforms-field-divider ace-h2\" data-field-id=\"19\"><h3 id=\"wpforms-18850-field_19\" name=\"wpforms[fields][19]\">Pain Knowledge Questions<\/h3><div class=\"wpforms-field-description\">We'd like to understand where you're starting from in your scientific knowledge about pain.\r\nHere's your chance to show us what you know!<\/div><\/div><div id=\"wpforms-18850-field_33-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"33\"><div id=\"wpforms-18850-field_33\"><div style=\"margin-bottom: 10px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_20-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_20\">1. Pain only occurs when you are injured or at risk of being injured.<\/label><ul id=\"wpforms-18850-field_20\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_20_7\" name=\"wpforms[fields][20]\" value=\"True\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_20_7\">True<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_20_1\" name=\"wpforms[fields][20]\" value=\"False\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_20_1\">False<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_21-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_21\">2. Your brain decides when you will experience pain.<\/label><ul id=\"wpforms-18850-field_21\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_21_7\" name=\"wpforms[fields][21]\" value=\"True\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_21_7\">True<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_21_1\" name=\"wpforms[fields][21]\" value=\"False\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_21_1\">False<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_22-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_22\">3. It is possible to have pain and not know about it.<\/label><ul id=\"wpforms-18850-field_22\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_22_7\" name=\"wpforms[fields][22]\" value=\"True\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_22_7\">True<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_22_1\" name=\"wpforms[fields][22]\" value=\"False\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_22_1\">False<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_23-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_23\">4. Chronic pain means that an injury hasn\u2019t healed properly.<\/label><ul id=\"wpforms-18850-field_23\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_23_7\" name=\"wpforms[fields][23]\" value=\"True\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_23_7\">True<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_23_1\" name=\"wpforms[fields][23]\" value=\"False\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_23_1\">False<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_24-container\" class=\"wpforms-field wpforms-field-radio ace-h3\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_24\">5. In chronic pain (ie: pain that persists), the brain and nervous system become more sensitive to the signals coming from injured areas.<\/label><ul id=\"wpforms-18850-field_24\"><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_24_7\" name=\"wpforms[fields][24]\" value=\"True\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_24_7\">True<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-18850-field_24_1\" name=\"wpforms[fields][24]\" value=\"False\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_24_1\">False<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_38-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"38\"><div id=\"wpforms-18850-field_38\"><div class=\"py-3\" style=\"border-top: 2px solid #f07561; margin-top: 30px; margin-bottom: -20px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_30-container\" class=\"wpforms-field wpforms-field-divider ace-h2 wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><h3 id=\"wpforms-18850-field_30\" name=\"wpforms[fields][30]\">Submission<\/h3><\/div><div id=\"wpforms-18850-field_39-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"39\"><div id=\"wpforms-18850-field_39\"><div style=\"margin-bottom: 5px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_41-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"41\"><div id=\"wpforms-18850-field_41\"><p style=\"font-weight: 600; font-family: \"Rubik\"\">The BOOST Recovery program involves extensive contact with a specialist health care professional and the cost will not be covered by Medicare. Private Health Insurance typically does not cover pain programs either. Our company and others are lobbying for changes to the system so that pain care is accessible for everyone. <span style=\"color: #ed1c24\">*<\/span><br><\/p><\/div><\/div><div id=\"wpforms-18850-field_9-container\" class=\"wpforms-field wpforms-field-checkbox ace-h3 wpforms-conditional-trigger\" data-field-id=\"9\"><label class=\"wpforms-field-label wpforms-label-hide\" for=\"wpforms-18850-field_9\">Cost Disclaimer - Agree to Proceed <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-18850-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-18850-field_9_1\" name=\"wpforms[fields][9][]\" value=\"I understand that there is an out of pocket cost associated with the program.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-18850-field_9_1\">I understand that there is an out of pocket cost associated with the program.<\/label><\/li><\/ul><\/div><div id=\"wpforms-18850-field_42-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"42\"><div id=\"wpforms-18850-field_42\"><div style=\"margin-bottom: 10px\"><\/div><\/div><\/div><div id=\"wpforms-18850-field_46-container\" class=\"wpforms-field wpforms-field-captcha\" data-field-id=\"46\"><label class=\"wpforms-field-label\" for=\"wpforms-18850-field_46\">Captcha <span class=\"wpforms-required-label\">*<\/span><\/label><p id=\"wpforms-18850-field_46-question\" class=\"wpforms-captcha-question\">What is 1+1?<\/p>\n\t\t\t<input type=\"text\" id=\"wpforms-18850-field_46\" class=\"wpforms-field-medium wpforms-field-required a\" data-rule-wpf-captcha=\"qa\" data-is-wrapped-field=\"1\" data-a=\"2\" name=\"wpforms[fields][46][a]\" aria-describedby=\"wpforms-18850-field_46-question\" required>\n\t\t\t<input type=\"hidden\" name=\"wpforms[fields][46][q]\" value=\"2\">\n\n\t\t\t<\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"18850\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-18850\" class=\"wpforms-submit eoi-button\" data-alt-text=\"Submitting...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/brainchanger.io\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Brain Changer BOOST Recovery Program Expression of Interest This form will give [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/pages\/18864"}],"collection":[{"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/comments?post=18864"}],"version-history":[{"count":28,"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/pages\/18864\/revisions"}],"predecessor-version":[{"id":18933,"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/pages\/18864\/revisions\/18933"}],"wp:attachment":[{"href":"https:\/\/brainchanger.io\/wp-json\/wp\/v2\/media?parent=18864"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}