Life is stressful enough for a person who has been diagnosed with cancer. At Cancer Center for Healing, we believe that finding out where to get the best medical care possible shouldn’t add to that stress. Therefore we try to make learning about our center as easy as possible and try to make the new patient process not just stress-free, but a positively enjoyable experience.

Please fill out the required fields in the below medical questionnaire. Once you have entered in all your information, please click “Send”. Once Dana receives your information she will contact you to arrange a consultation with one of our Integrative Cancer Specialists. After the consult, we will customize a treatment plan for you.


Insurance Information

Please send a copy (front & back) of your insurance card so we can verify coverage prior to your consultation via email to or via fax to (949) 606-8931.


Medical Records

In lieu of medical records, please send a copy of all pertinent scan reports (MRI, Ultrasounds, PET) and all pertinent labs taken in the last 3 months via email to or via fax to (949) 606-8931.



New Patient Medical Questionnaire

 **PLEASE NOTE: Please fill in all the required fields of the New Patient Medical Questionnaire (fields with “*”). Your submission was successful if you receive a confirmation email with a copy of your submission. An Integrative Cancer Specialist will contact you within 24 hours of your submission during normal business hours (our offices are closed Saturdays and Sundays).

  • Patient Information

  • Medical History to Date

  • Insurance

  • Other




Call (949) 581-HOPE (4673) with any questions or to schedule a personal consultation with an Integrative Cancer Specialist. You can also email us at , or chat with us live. In addition to office visits, we also offer telephonic and Skype consultations for patients who are unable to make in-person visits. We consult with patients from all over the world. We are here to walk you through your healing process every step of the way.