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Autism Spectrum
SPECTRUM CASE STUDY
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Date of Birth *
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MEDICAL HISTORY
Medical History:
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Tobacco Use
Alcohol Use
Are you currently taking supplements or prescription medications?
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What medications and supplements are currently being taken?
Any known allergies?
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What causes your allergic reactions?
Other illnesses not listed:
Any surgeries in the past 5 years?
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Previous Surgical History:
Type of Diet
Family History
Has Cannabis been used before & what has been used?
The information contained herin is neither intended to dictate what constitutes appropriate or best care for any given health issue, nor is it intended to be used as a substitute for the independent judgement of a physician. Rylie's Smile Foundation is under constant development and striving toward advancements in research. We reserve the right to use collected intellectual property for the advancement of understanding the role of medical cannabis in improving serious diseases and ailments that affect quality of life. We thank you for being a part of this mission.
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