We are dedicated to empowering you and supporting your journey toward healing, improved health and NOT letting cancer take more of you than it already has.

Your insights are invaluable, and your responses will help us tailor our resources and programs to support your goals. Thank you for being here and sharing a bit about yourself with us.

With gratitude and excitement,

After the Bell Cancer Academy Co-Founders
Alison Doty
Staci Smith

Please provide your name and address to receive your free gift. Your email is your login to free classes and a link will be sent to you by both email and text. Kindly indicate your gender at birth, as this survey is for women’s research purposes. However, we welcome all genders.

First Name

Last Name

Email-This is your login ID

Phone-This will allow access to the mobile version of your account

Street Address - This information will allow us to send gifts and other items associated with the courses

City

State

Postal code

Gender

Type of Cancer if not listed above

Are you currently cancer free? *

Yes

If you are currently cancer free, how many years?

Have you had a reoccurance since your first diagnosis? *

Yes

How long were you cancer free before recurrence?

What age were you when your cancer treatments were complete?

Do you have side effects from any after treatment medication such as a hormone blocking medication? With 1 being "not at all" and 5 being "severe side effects". *

Did/do you attend any support groups? *

1. No, I had/have a great support system.

2. No, it was/is not convenient.

3. No, it was/is too far away.

4. Yes, it worked when I needed it.

5. Yes, and still going.

Has the cancer diagnosis changed your lifestyle? With 1 being "Nope, it's still the same" and 5 being "Yes, this has been completely life altering." *

Comment

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.