REHABILITATION PROGRAMME APPLICATION FORM

First Name

Last Name

Phone

Street Address

Region/State/Province

Age

Street Address Line 2

City

Postal / Zip code

What is your diagnosis?

What treatment are you currently going through. Please provide details

Please provide details of any issues / restrictions you are experiencing

Please provide details of all medication you are currently taking

We are currently only accepting applicants who are over 18 years old, please confirm this by ticking box that you are above 18 years old.

I give permission to Ahead Of The Game to send me any email correspondance including marketng emails

Today's Date

After clicking "Submit" below, you'll be redirected to the exclusive Ahead Of The Game Member's Hub.

While you're on the waiting list, you'll gain immediate access to valuable support and resources, including Dave's comprehensive health protocol, details on nutrition, supplementation, therapies, essential information, and our fully funded/free classes such as yoga and Pilates. You'll also have access to pre-recorded classes, courses, and partnership discounts for you and your caregivers.

Please create an account and book any classes or courses you’re interested in. You’re welcome to attend as many or as few as you like—they’re designed to support you while you await your placement with our Cancer Rehabilitation Specialist Coaches.