Cancer Questionnaire Cancer Questionnaire This Cancer Questionnaire should be filled out, if applicable, where you have been diagnosed with cancer. Step 1 of 4 25% Name First Last Email When were you diagnosed with cancer? What is your original diagnosis?What is your current diagnosis?What is the original site of your cancer?What type of cancer is it?What parts of the body has it spread to?What is your current prognosis? Please list all medical treatments have you received in the last two years.Please list any surgeries you have had. Please list current nutritional supplements being taken.List all alternative therapies currently being done (massage, colonics, etc.) What is you current pain level? (between 1 and 10)Please enter a value between 1 and 10.How many hours of sleep are you getting a night?Please enter a value between 0 and 24.Please list your history of chemo & radiation treatments. Are you still doing chemo or radiation, if yes, how many sessions do you have left? Please enter a value between 0 and 100.Who is the physician that diagnosed the cancer? First Last When did the doctor diagnose the cancer?