Brain Changer Pain Recovery Program
Hi there, we're glad you've made it to this form, and you'd like to register your interest in the Brain Changer Program.

This form will give the team at Brain Changer some background information on how you understand and live with pain at the moment. This information will help us tailor information to you when discussing how the program works.
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Do you understand that filling out this form means that you would like to be contacted directly by Brain Changer with information about enrolling in the Pain Recovery Program? *
Name:
Contact Email: *
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're in: *
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