Chronic Pain Self-Management Program Workshop Registration
Chronic Pain Self-Management Program (CPSMP) is an evidence based program developed by Stanford University as a tool to help people with chronic health conditions. Classes are highly participatory. Mutual support in the group builds participants’ ability and confidence to manage their chronic pain.

Anyone with chronic pain or helping to care for a person with chronic pain is welcomed to participate, with the following requirements:
1. Commitment to attend all 6 classes online
2. Be interactive in class
3. Do the homework after each class
4. Fill out all the required forms

Workshop Timing: 03/12/2026 - 04/16/2026; Every Thursday, 3:00-5:30 PM for six weeks

JOIN US and Live a Healthy Life with Chronic Pain!
We look forward to meeting you!

Contact Yuhsin Chou at yuhsin.chou@ccacc-dc.org or (301) 663-1375
Heidi Huang at shiyu.huang@ccacc-dc.org or 301-663-0983 for any questions.
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Email *
First Name *
Last Name *
Maryland Address *
Street Address, Apt/Unit #, City, State
Zip Code *
Phone Number *
Date of Birth *
MM
/
DD
/
YYYY
Did your doctor or other health care provider suggest that you attend this program? *
Insurance Status *
How old are you today? *
Do you live alone? *
Are you of Hispanic, Latino, or Spanish origin? *
What is your race? Check all that apply. *
Required
If you chose Asian, which Asian subgroup do you identify with? *
Required
What is your current gender (select one)? *
Which of the following best represents how you think of yourself? [Select ONE]:
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What is the highest grade or year of school you completed? *
Have you ever served in the military? *
During the past year, did you provide regular care or assistance to a friend or family member who has a long-term health problem or disability? *
In general, would you say that your health is: *
Has a health care provider ever told you that you have any of the following chronic conditions (i.e., one that has lasted for three months or more)? *
Required
Are you deaf or do you have serious difficulty hearing? *
Are you blind or do you have serious difficulty seeing, even when wearing glasses? *
Do you have serious difficulty walking or climbing stairs? *
Do you have difficulty dressing or bathing? *
Because of a physical, mental, or emotional condition, do you:   Have serious difficulty concentrating, remembering, or making decisions? *
Because of a physical, mental, or emotional condition, do you:  Have difficulty doing errands alone such as visiting a doctor’s office or shopping? *
How often do you feel lonely? *
How often do you feel isolated from those around you? *
How sure are you that you can manage your condition so you can do the things you need and want to do? *
Totally unsure
Totally sure
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