Client Registration Form

Please enable JavaScript in your browser to complete this form.

Registration Form

Thanks for your payment. To activate your account, please complete the registration form below.

Your Details

do do average,

Name *

First

Last

Email *

Mobile *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Disclaimer 3 *

I agree to the CURABLE Terms and Conditions.

Save and Resume Later

Secondary Contact Details

Friend or Family Member's Name

First

Last

Contact Email

Contact Mobile

Save and Resume Later

Personal Information

Date of Birth

DOB - DD *

DOB - MM *

DOB - YYYY

Place of Birth

POB - City *

POB - State *

POB - Country *

Place of Birth *

City, State, & Country

Marital Status

Ages of children *

Occupation *

Save and Resume Later

Health Information

Select a unit of measurement

Metric (cm and kg)
Imperial (feet, inches and lbs)

Height (cm) *

Weight (kg) *

BMI *

You fall into the Underweight category. Please note that these descriptions are a rough guide and are not intended to be definitive.

You fall into the Healthy weight category. Please note that these descriptions are a rough guide and are not intended to be definitive.

You fall into the Overweight category. Please note that these descriptions are a rough guide and are not intended to be definitive.

You fall into the Obese category. Please note that these descriptions are a rough guide and are not intended to be definitive.

If you are 6 ft 5 in, enter 6 in the Height (ft) column and 5 in the Height (in) column.

Height (ft) *

Height (inches) *

Weight (lbs) *

BMI *

You fall into the Underweight category. Please note that these descriptions are a rough guide and are not intended to be definitive.

You fall into the Healthy weight category. Please note that these descriptions are a rough guide and are not intended to be definitive.

You fall into the Overweight category. Please note that these descriptions are a rough guide and are not intended to be definitive.

You fall into the Obese category. Please note that these descriptions are a rough guide and are not intended to be definitive.

Type of cancer, size of tumour(s), dates of diagnoses and method(s) of detection *

Allopathic medical treatments received *

Click here to see more examples of allopathic medical treatments. If not applicable, write N/A

Naturopathic medical treatments received *

Click here to see more examples of allopathic medical treatments. If not applicable, write N/A

What symptoms of illness do you have nowadays? *

If not applicable, write N/A

What pain and discomfort, are you experiencing these days? *

If not applicable, write N/A

Physical factors that may have triggered cancer *

If not applicable, write N/A

Emotional factors that may have triggered cancer *

If not applicable, write N/A

Environmental factors that may have triggered cancer *

If not applicable, write N/A

Do you smoke cigarettes? *

Weekly alcohol consumption *

Recreational drug consumption *

Pharmaceutical medications currently taken *

Which covid vaccine(s), if any, have you taken? *

Naturopathic supplements currently taken *

Types and frequency of physical exercise *

Do you use non-organic chemical forms of these products?

shampoo/conditioner
deodorant
hair dye
toothpaste
household cleaning products
washing detergents
cosmetics

Do you have any dental amalgams? *

Do you use a microwave oven? *

Do you use Teflon pots and pans? *

How much water do you drink each day?

On average, how many bowel movements do you have each day?

What have you typically been eating for breakfast? *

What have you typically been eating for lunch? *

What have you typically been eating for dinner? *

What snacks do you typically eat? *

What drinks do you typically consume? *

Save and Resume Later

Your Beliefs

What is your belief that you can achieve a complete recovery using modern allopathic medicine?

Your Belief: 50%

What is your belief that you can achieve a complete recovery using naturopathic medicine?

Your Belief: 50%

What is the level of support from family and friends you are receiving for pursuing a holistic healing path?

Your Belief: 50%

What is your average energy level?

50%

What is your level of anxiety regarding your health?

50%

Have you read “The Healing Power of Cancer” by Rob Prior? *

What were your biggest lessons from reading this book? *

To what extent have you followed Rob’s protocols? *

Have you read “Say Hello To Happiness (The Healing Mindset)” by Michael Adamedes and Rob Prior? *

What were your biggest lessons from reading this book? *

How has it helped you? *

Do you have any further comments or questions? *

Checkboxes

First Choice
Second Choice
Third Choice