Canna Healing Consulting Intake Form
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Email *
Name *
Address
Phone
DOB
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Weight
Health challenges you wish to address
Previous/current treatments (surgery, physical therapy, acupuncture etc)
Current medications
Have you ever used cannabis?
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If you have used cannabis, how often, what dosage, what delivery method
Have you ever had adverse reactions to cannabis?
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Do you drink alcohol or use any other substances
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Do you have a medical marijuana certification
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