Taking Your Life Back from Cancer: 4-Week Live Virtual Program: Medical Questionnaire and Disclaimer

  • This field is required. Please use the email address you registered with Evicting Cancer for the first time.
  • Date Format: MM slash DD slash YYYY
  • Rate yourself on the following (0=never, 1=rarely and 5=regularly)
  • Challenges to living your desired life (rate from 1-5 with 5 being most severe)
  • Disclaimer: Understanding the Purpose of Program

    I understand that the information I receive from this “Taking Your Life Back from Cancer” 4-week program is not to be construed as medical advice, diagnosis or prognosis. I understand that this is an educational forum that supports me in harnessing my body’s innate healing capacities to improve the efficacy of my chosen treatment while lessening side effects. I understand the program is not a substitute for professional medical advice or supervision and I should visit my physician and/or licensed mental health professional for any physical or psychological conditions I have.

    I understand that I am being empowered to make more informed dietary, lifestyle and self-care decisions that can supplement and enhance my chosen medical cancer treatment –allowing me to create a better cancer healing journey. It is my responsibility to discuss these choices/decisions with my medical providers to make sure they are in alignment with my existing treatment.

    I realize the importance of advising my doctor on what I am doing so that s/he can supervise my care and appropriately and safely adjust my medications/treatment plan if needed as a result of my learning to better harness my body’s own natural healing potential.

    I am ready to take my life back from cancer.

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