Moving Through Cancer Registry
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Contact Person/Program Director
Contact Information
Contact Email
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Address Line 2
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UM-81
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UM-84
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UM-86
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Program Website
Program Description
Resource Type
Clinic or Hospital (inpatient)
Community
Clinic or Hospital (outpatient)
Home Based
Cancer Exercise Professional
Digital/Online
Research Study
What age groups are included (check all that apply)?
Adult
Pediatric
What stages of treatment are included (check all that apply)?
Curative
Palliative
During Treatment
Post Treatment
Rehabilitation
Prehabilitation
Who refers into the program? (How do clients access your program?) (check all that apply)
Client
Clinician
Other
Is there a baseline safety evaluation of the client?
yes
no
What is the program duration? (e.g.; 12 weeks, 1 year)
What is the frequency of sessions per week?
Are sessions conducted in groups or individualized (check all that apply)?
Group
Individual
How many years has the program been running?
How many clients go through your program per year?
Has your program ever been evaluated or audited?
yes
no
Please include a brief description (250 words or less) summarizing the above information:
About You
Who filled out this form?
What is your role in the program?
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