Self-Referral Form (Living Well with Chronic Pain)

1. Living Well with Chronic Pain information and criteria

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This form is intended for people who would like to apply for a place on Artlift’s Living Well with Chronic Pain programme.  

If you need help with this form and/or need to apply in another format, please contact us: 01452 222 726 or artlift.referrals@nhs.net. 

Please note that an offer of a place on one of our courses is subject to your providing the contact details of a health professional involved in your care, and to availability of (limited) spaces. 

ABOUT THE LIVING WELL PROGRAMME

Artlift offers non-clinical group courses in community venues as well as online when there is adequate demand.  Sessions are free, and materials will be provided. No artistic skills or talent are necessary. 

Click here to read more about the programme.

Our Living Well with Chronic Pain programme offers:

  • A chance to get creative and meet others (if in a group) over 8 x 2-hour sessions.
  • Creative Check-ins (one-to-one conversations) with a specially trained Artist Facilitator to help you embed and sustain creative activities.
  • Move On plans, so that you can continue to use arts as a tool and to meet up with others (if you wish) to support ongoing improved wellbeing.

CRITERIA FOR PARTICIPATION

Our Living Well with Chronic Pain programme is for adults who are:

  • Over 18 and registered with a GP in Gloucestershire
  • Living with persistent, debilitating pain for over 3 months
  • Experiencing significant emotional distress and/or interference in daily life due to pain
    Comfortable in a group setting
  • Able to follow simple instructions or demonstrations
  • Committed to attending as many of the sessions as possible
  • If being referred for an online course, willing / able to use Zoom, with a computer or tablet and quiet space where sessions can be accessed (N.B. we can support with Zoom familiarisation)

If there’s anything you are unsure about, please don’t hesitate to contact us to talk this through before completing the referral form.

 

 

1. How did you hear about this Artlift programme? *

 

2. Have you been referred to Artlift in the past? *

 

3. Have you engaged with Gloucestershire Hospitals’ NHS Pain Management Service?  *

 

4. Would you be interested in our creative dance course? *