Oncology Report Organization

Oncology Intake

This form helps us organize your reports and prepare your session. Share only what you're comfortable sharing.

Client Information

Full Legal Name *Preferred NameDate of Birth *Mobile Phone *Email Address *How did you hear about us?

Your Care So Far

Diagnosis, in the words your care team used

Approximate date of diagnosisOncology team or cancer centerWhere are you in your care?Next oncology appointment (if known)

What types of reports are you submitting, and when were they issued?

Would you like a caregiver to join the session?

Upload Your Reports

Add each report under the closest category. PDFs and images are fine, up to 50 MB each. Each completed test or scan counts as one report, even if several results come in the same PDF. If a file is larger than 50 MB, split it into parts and upload each part.

Pathology / biopsy reports

Add file(s)

Imaging (CT, PET, MRI, ultrasound, mammogram)

Add file(s)

Bloodwork / tumor markers

Add file(s)

Genomic or biomarker testing

Add file(s)

Treatment summaries / visit notes

Add file(s)

Other

Add file(s)

Questions & Nutrition

What questions or confusing terms would you like help with?Any nutrition concerns? (appetite, taste changes, weight changes, digestion, food questions)Supplements or herbs you're currently taking

On a scale of 1 to 10, how overwhelmed do you feel by your reports?

Consent & Signature

I understand that Oncology Report Organization is an educational session that organizes my existing reports, explains terminology in plain language, and helps me prepare questions and nutrition topics for my care team. It does not interpret treatment options, recommend or evaluate medications, provide a cancer protocol, or replace my oncology team. All treatment decisions remain with my medical providers. I confirm the information above is accurate and authorize review of the reports I have uploaded.

Client Signature *

Sign with your mouse or finger.

Date *

After you submit: our office will call you to collect payment and schedule your 30-45 minute virtual session. You do not pay through this form.