Cancer Free Living Program Waitlist
The Cancer Free Living Program is currently at capacity, and this form is now being used as the official waitlist. By completing this form, you will be added to the waitlist and notified if a spot becomes available or when the next cohort opens. Waitlist members receive priority notification.Thank you for your interest and for taking this step toward your life after cancer.
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
AGE
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Gender
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Please Select
Female
Male
Non-Binary
What type of cancer were you diagnosed with?
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Have you completed active cancer treatment—such as surgery, chemotherapy, or radiation—within the past 5 years?(Hormonal therapy and CDK inhibitors do not count as active treatment for this program.).
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Yes
No
Do you have any major physical limitations that prevent you from performing basic functional movements (walking, light stretching, or similar activities)?
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Yes
No
Are you comfortable speaking English and able to join weekly Zoom sessions?
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Yes
No
Are you willing to complete the program materials, fill out the surveys, and participate fully in the group coaching sessions for 12 weeks? Note: This is a 100% virtual program that meets once a week in the evening.
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Yes
No
Why do you want to join this program? (check all that apply)
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I want to feel in control of my health again.
I want to reduce my risk of recurrence.
I want to rebuild my strength, energy, and confidence
I want support from a community of survivors.
Is there anything else you’d like to share about your health, wellness goals, or what you hope to gain from this program?
How did you learn about this program?
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