Medical Survey
In order to make sure we are providing our members with the best possible medical products please take your time to fill in our survey.
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Name *
Membership Number
Gender *
Weight (in kg)
Height (in cm) *
Preferred Medical Product
 *
Please select the way you prefer to treat your condition when you medicate.
Preferred Product or Strain Name *
For Example: E-Harmony CBD or Amnesia Haze
If flower or hashish, how do you consume?
Please select your normal type of consumption.
Clear selection
Name of Medical Condition
Please tell us the name of your condition.
Medical Information
 *
Please provide some background info on your condition.
Please the effect cannabis products have on you
 *
Please select as many as apply.
Required
Extra information on the effects
If you want to go into detail about the effect please write here.
Medical Users only: Level of Pain BEFORE Cannabis
Clear selection
Medical Users only:  Level of Pain AFTER Cannabis
Clear selection
Product Effectiveness
 *
Please select how well you feel the product has worked for you
Submit
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