Patient Registration Survey
Thank you for taking the time to fill out our first survey, your feedback is extremely helpful in ensuring a successful therapeutic cannabis program. Please forward to other potential patients to provide additional feedback.
Email Address
Phone Number
Have you spoken to your provider (physician or APN) about the Therapeutic Cannabis Program?
Clear selection
Is your provider willing to certify you for the program at this time?
Clear selection
If your provider did not certify you, what was the reason given?
Clear selection
Did your provider have questions regarding the program's paperwork and/or process?
Clear selection
Would you be interested in learning more about providers in the area who would be willing to certify you for the therapeutic cannabis program?
Clear selection
Please provide any additional questions or comments below. We'd love to hear from you!
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