Colorado Chronic Pain Assistance Program

WELCOME TO C.C.P.A.P.

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The Colorado Chronic Pain Assistance Program is designed and created by a chronic pain sufferer, for the chronic pain sufferer. If you suffer from any kind of chronic pain on a daily basis; you may benefit from our help, guidance and information. Please allow us to hold your hand and walk you through a system of rehabilitating steps that will provide you with the tools you will need to help you manage your pain and learn how to live with it.

*ATTENTION VETERANS*

WE WOULD LIKE TO PUT A CALL OUT TO ALL VETERANS WHO ARE SEARCHING FOR HELP WITH THESE THREE ISSUES :::

Chronic pain (possibly Reflex Sympathetic Dystrophy Syndrome/R.S.D.)
Post Traumatic Stress Disorder (P.T.S.D.)
Closed head injuries

We would love to help you in any way we can. At this time we can offer you a free pain packet full of information on how to deal with chronic pain, lists of the best chronic pain web-sites, books and a chronic pain nutritional plan along with a seven day menu. We can also offer one on one counseling with either myself (a chronic pain sufferer who has been diagnosed with and understands P.T.S.D.) or with Miles, a fellow chronic pain sufferer with P.T.S.D. and veteran of the Vietnam WAR.

Please bear with us as we are in the beginning phases of our strategy to help you get a handle on your chronic pain and stress. There is a volunteer questionnaire form at the bottom of this page. If you would like to fill it out and e-mail it back to us, it would greatly help us - help you! We simply need to know what your needs are as a chronic pain sufferer. If you would rather contact us to make an appointment to discuss your needs face to face, we can do that. Either way - please know that we are here - we care - we want to help you - and, most importantly; we believe that we can make a difference!

DISCLAIMER: We are not doctors. We are chronic pain sufferers. Any advice or information you receive should be evaluated with your doctor before making any health decisions.

C.P.A.P. is a non-profit organization.

Matthew 7:7-8

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COLORADO CHRONIC PAIN ASSISTANCE PROGRAM

QUESTIONNAIRE FORM

THIS IS A VOLUNTEER QUESTIONNAIRE

In order for C.C.P.A.P. to better serve you, we have put together this simple questionnaire. If you would like to take the time to fill it out and e-mail it to us at smal1k@netzero.com it would greatly help us! We need your knowledge to further serve our chronic pain community. All information will remain confidential to our office.

Thank You -

The Colorado Chronic Pain Assistance Program

(C.C.P.A.P.)

Name :	DOB :
eMail :

What is the cause :
Pain Level ( 10 being highest ) :
How long have you been a chronic pain sufferer ?
Do you use a cane/wheelchair to get around ?
Do you work outside of your home ?	Hours/Week
Do you have support from family and friends ?
Do you see yourself getting better or possibly being cured someday ?
Are you on any prescription medications for your chronic pain ?	If so, what ?
What are your basic needs as a chronic pain sufferer ?
In a few words, explain how we can help you :