Submit your pain story

Over 50 million people suffer from chronic pain but everyone has a unique story about their pain. We'd like to hear your story and it may even be part of our film as we aim to show the breadth of this serious and misunderstood disease.
To take part in this massive effort, please follow the steps below to submit your pain story to share with the world.
Please note: You are expressly agreeing to all of the terms and conditions below by continuing on this website and/or by uploading your video.

1) Find a quiet location in front of a background with little to no items (like a blank wall) and good front-lighting. A propped or mounted phone is best, but a handheld video by you or another person is fine, just try to be as steady as possible.
2) Use your phone in landscape mode and make sure that any settings that lock the phone in “portrait mode” are turned off.
3) Once you start recording, wait five seconds and then tell your story and attempt to answer these questions (but no need to read the questions aloud):
- How long have you had pain?
- What have you tried, or are considering to try, to relieve the pain?
- What's been most effective?
- Did anything you tried make the pain worse?
- Any other details you'd like us to know?
- Any thoughts on the health care “industry?”
4) Try to keep the video under 5 minutes or as close to that as possible.
5) Complete the form below, click ‘submit,’ and you’ll be taken to a dropbox uploader where you can upload your file. (The dropbox uploader will also request your name and email address, which is how we will link your file to your agreement.)

First Name

Last Name

Agreement

I acknowledge, understand, agree, and accept the following: I am making several promises to you by sharing my story. First, I'm promising that I am sharing my own story and information. That I'm allowed to share it, that I'm freely sharing it, and it doesn't affect the rights of any third-party. Second, that I'm expressly giving you the right to share my story in any way you should choose, including reproducing all or a part of the story, all around the world, forever. You can use my name, my voice, my likeness, and any other information that I share. I will never take this right back from you and I give up any rights that I may have to review the content of the story I've shared or how it's used by you. Third, I am granting you the right and freedom to share any medical information that I provide in my story even if that information would generally be protected under privacy rights, HIPPA, and other rules, laws, etc. Finally, I'm promising that I will not assert any claims of any nature whatsoever, against anyone, relating to the use of my story, the other promises I've made, and the rights I've granted you.