Queering Chronic Pain - interest form

Please fill out this form to tell me about your physical therapy needs.

Name

Phone number

Email

Reason(s) you are seeking physical therapy

Types of treatment you are looking for:

In-person 1:1 physical therapy in your place of residence (available in Oakland, CA and surrounding areas)

Virtual 1:1 physical therapy (must be in CA for this option)

Virtual 1:1 pain coaching (available anywhere)

Queering chronic pain group (10 week small cohort-style virtual class, available anywhere)

If you are seeking 1:1 care, how often do you anticipate accessing care?

Multiple times per week (currently unavailable - I recommend seeking care at a local PT clinic if you need to see a PT multiple times per week for an acute injury, after surgery, etc).

Once per week

Once every other week

1-2 sessions for consultation/to develop a self care program

Not sure

Queering chronic pain consists of politicized physical therapy and pain coaching. I am dedicated especially to serving trans, queer, disabled and neurodivergent people, as well as social justice organizers/activists. Please indicate if you believe it makes sense for you to access this service.

Queering chronic pain consists of politicized physical therapy and pain coaching. I am dedicated especially to serving trans, queer, disabled and neurodivergent people, as well as social justice organizers/activists. Please indicate if you believe it makes sense for you to access this service.

yes

Up front pricing: I do not contract with any insurance companies, but can provide superbills for you to submit for reimbursement. I strive to ensure my services are accessible to as many people as possible, given my own constraints. I provide services on a sliding scale based on a discussion and agreed upon amount.

I try to include as much treatment and information as I can during each session, to decrease the number of sessions needed and decrease your cost. The average number of sessions is around 4-5 per issue/injury/concern (though this can vary by client preference/need/etc). Many clients return for follow up as needed, or for new injuries/issues later down the line. Please keep this in mind when budgeting for services.

My “going rates” are:

-PT evaluation (generally 90 mins but can be as long as 120 mins if needed): $240

-PT follow up session (50-60 mins): $190

-Charge for in-person visit greater than 5 miles from zip code 94619: $5/mile (for example, if you live 7 miles from me, the charge is $10).

- Pain consultation initial session (80-90 mins): $220

- Pain coaching follow up session (50-60 mins): $170

- Queering Chronic Pain group: $80-$600 sliding scale ($10-$75 per 1.5 hour session)

Based on the information above, please select one of the following choices:

I can pay your going rate.

I can pay your going rate, but will need to limit the number of sessions.

I will need to discuss sliding scale options

I am only interested in group classes

Thank you for your interest! I will be in contact with you shortly. If you are interested in the Queering Chronic Pain group, you will be placed on the interest list and contacted when the next course is enrolling.