Patient Qualification

Use the Survey below to see if you qualify!

Take our easy qualification survey to see if you qualify for a Medical Marijuana recommendation today!

Let's start with some basic patient information.

Please select your medical condition

My condition affects my everyday life
1: Not at all2: Half the time3: All the time  
I have constant pain from my condition
1: Not at all2: Half the time3: All the time  
I can not do the things I enjoy because of my condition
1: Not at all2: Half the time3: All the time  
I have been prescribed medications with the the possibility of addiction and or adverse side effects
1: Not at all2: Half the time3: All the time  
I do not sleep well or at all because of my condition
1: Not at all2: Half the time3: All the time  
My condition has impacted my relationship with friends and or loved ones
1: Not at all2: Half the time3: All the time  
I have had to alter my life drastically because of my condition
1: Not at all2: Half the time3: All the time  
If medical marijuana is able to help with my condition, It would make my quality of life much better
1: Not at all2: Half the time3: All the time