Is Medical Marijuana Right for You?

 

To determine if you are a candidate for medicincal marijuana, complete our brief questionnaire below. Once completed, if you are a suitable candidate, you will be able to download our guide about how to talk to your doctor about medicinal marijuana. This helpful guide will make having the conversation with your doctor easier. Start the questionnaire now.

Home Is Medical Marijuana Right for You?

 

Are you currently suffering from a medical condition that traditional medicine is not effective?

Yes

No

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Are you currently experiencing any of these symptoms?

  • Pain
  • Conditions affecting Mental State or Mood
  • Conditions affecting your stomach and/or eating patterns
  • Conditions such as Eplilepsy, Multiples Sclerosis or other neuro-muscular diseases

Yes

No

*Please Select Options

Is your condition affecting your quality of life?

Yes

No

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Do you have a history of any of the following conditions?

  • Psychosis or schizophrenia or unstable psychiatric disease such as manic depressive illness
  • Unstable heart disease
  • Pregnancy, trying to become pregnant or breast-feeding
  • Allergy to marijuana/cannabis
  • Addiction to other drugs and/or alcohol

Yes

No

*Please Select Options
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Last Name:
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Email:
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Phone:
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ZIP/Postal Code:
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