Cannabis Survey for Medical & Recreational Use
Fill out this short survey to help us determine cannabis use needs as we fight for federal legalization in the United States foremost for medical use to ease the suffering of patients but also to prove their are many people wanting legalization for recreational use as well. No name is required so feel free to be honest and answer every question you can. The National Cannabis Patients Wall will use this information to validate our claims of need. Please share the survey on all social networks.
Are you currently being denied access to medical cannabis in your state?
Use other if you want to add a comment about how that affects you.
Yes
No
Other:
Do you use cannabis for medical or recreational purposes, or both?
Medical
Recreational
Both medical and recreational
How long have you used cannabis?
Less than 1 year
More than 1 year but less than 2
More than 2 year but less than 3
More than 3 year but less than 4
More than 4 year but less than 5
More than 5 year but less than 6
More than 6 year but less than 7
More than71 year but less than 8
More than 8 year but less than 9
More than 9 year but less than 10
More than 10 year but less than 11
More than 11 year but less than 12
More than 12 year but less than 13
More than 13 year but less than 14
More than 14 year but less than 15
More than 15 year but less than 16
More than 16 year but less than 17
More than 17 year but less than 18
More than 18 year but less than 19
More than 19 year but less than 20
More than 20 years
Other:
Age
Current age of the person this information on the form is about. Family members are welcome to participate and should fill the form out for each family member seperately we need all of the input we can get.
Under 18
18 - 25
26 - 35
36 - 50
51 - 60
61 - 70
70+
If you use medically what illness or illnesses do you use cannabis for?
Check all illnesses that cannabis helps relieve symptoms of.
A chronic or terminal disease
Alzheimer's
Arnold-Chiari Malformation & Syringomyelia
Ataxia
Cachexia (wasting syndrome)
Cancer (List specific type of cancer in followup)
Cardiopulmonary Respiratory Syndrome
Causalgia
Chronic inflammatory (demyelinating
Chronic Pain
Crohn's disease
Dystonia
Epilepsy
Fibromyalgia
Glaucoma
Hepatitis C
HIV/AIDS
Hydrocephalus
Inflammatory Bowel Disease (IBS)
Interstitial Cystitis
Lou Gehrig's disease ( ALS)
Nausea
Seizures
Muscular Dystrophy
Muscle Spasms or Spasticity
Multiple Sclerosis
Myasthenia Gravis
Myoclonus
Nail-patella Syndrome
Neurofibromatosis
Painful Peripheral Neuropathy
Parkinson's Disease
Post-traumatic Stress Disorder (PTSD)
Reflex Sympathetic Dystrophy
Sjogren's Syndrome
Spinal Cord Disease & Injury
Tourettes
Diseases which result in nausea
Other:
WHAT KIND OF CANNABIS & DELIVERY METHODS USED
Do you use Indica, Sativa, or a combination of both?
Sativa
Indica
Combination of Sativa and Indica
What is the name(s) of your favorite strain(s)
List your top 3 favorite strains of cannabis.
Your answer
Why are they your favorite strains? What favorible effect (s) make these your favorite strain(s) of cannabis.
Relieves pain, stress, depression, nasaua, etc... or Makes me feel .....
Your answer
What type(s) of delivery system(s) do you use?
How do you take your cannabis? Check all that apply.
Eat raw as a vegetable.
Vegging or blending in mixer with fruits or vegetables.
Cook it into foods to make edibles.
Processed into cannabis oil.
Processed into topical applications.
Processed into hashish and smoked.
Smoke cannabis flowers.
Vaporize
Other:
Given the new scientific evidence of the health benefits of cannabis would you try new cannabis therapies.
If you had only smoked cannabis before would you try eating it, vegging it into a smoothie, or applying it toppically?
Yes I would try a new cannabis therapies.
No I would not try new cannabis therapies.
HOW MUCH CANNABIS USED FOR MEDICAL OR RECREATIONAL PURPOSES
These questions are very important as they will help determine the number of plants needed for a patients medical needs depending on their personal cannabis therapies or for citizens personal use. This information is useful for setting legal grow and use limits and as reference material for patients/members learning about cannabis use.
How many times per day do you eat or drink cannabis, edibles, and or drinks?
I do not currently eat or drink cannabis
Once
Twice
Three times
Four times
Five times
More than five times.
Other:
How many times per day do take cannabis oils?
I do not currently take cannabis oils.
Once
Twice
Three times
Four times
Five times
More than five times.
Other:
How many times per day do apply cannabis topically?
I do not currently apply cannabis topically.
Once
Twice
Three times
Four times
Five times
More than five times.
Other:
How many times per day do you smoke or vaporize cannabis or its extracts?
Once
Twice
Three times
Four times
Five times
More than five times.
Other:
How much cannabis do you eat or drink each day.
How much raw plant material is needed to make your oils, edibles, and or drinks
I do not eat or drink cannabis
Less than 1/8 ounce per day
1/4 Ounce
More than 1/4
How much cannabis do you smoke or vaporize each day.
The US Government prescribes 9 oz per patient per month in the Compassionate IND program = 12 joints per day. How much do you or would you smoke is allowed.
Less than 1/8 ounce per day (5 joints)
1/4 Ounce (10 joints per day)
More than 1/4 Ounce per day
Other:
Do you currently grow your own cannabis?
Yes
No
If given the opportunity would you grow your own cannabis?
Yes
No
If cannabis was on the ballot for legalization of medical use would you vote for it?
Yes
No
If cannabis was on the ballot for legalization of recreational use would you vote for it?
Yes
No
What state do you live in
Choose
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
DC District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
QUESTIONS FOR THOSE THAT HAVE PREVIOUSLY GROWN CANNABIS
These questions are very important as they will be valuable in determining the number of plants needed by each patient for their medical needs depending for their personal cannabis therapies.
Do you usually only grow indoor or outdoor to provide for your medical or recreational needs?
Choose
I usually grow indoors
I usually grow outdoors.
I grow both in and out of doors
Do you need to grow indoor and outdoor to provide for your medical or recreational needs?
Choose
I grow 1 outdoor crop and 1 indoor crop
I grow 1 outdoor crop and 2 indoor crops
I grow 1 outdoor crop and 3 indoor crops
If you grow outdoors are you able to grow enough for the year in one crop?
Choose
One grow provides for my yearly needs.
One grow does not provide for my yearly I needs. I have to grow two crops per year
How many plants do you need to grow to provide for your medical or recreational needs for a year?
1 to 12
13 to 25
26 to 50
51 to 75
75 to 100
More than 100
Other:
Do you grow all of the same strain of plants every season?
Yes all the same strain.
No I grow different strains.
Do you grow all Indica or all Sativa but more than one strain?
I grow a few different strains of Indica
I grow a few different strains of Sativa
Do you grow some Indica and some Sativa plants in one crop?
Mostly Indica with a few Sativa plants.
Mostly Sativa with a few Indica plants.
I grow half Indica and half Sativa plants.
Other:
On average how much does it cost you to grow an outdoor cannabis crop.
Your answer
On average how much does it cost you to grow an indoor cannabis crop.
Your answer
FOR CONTEST PURPOSES ONLY: NOT REQUIRED
To enter our giveaways you need to provide your facebook username and if you are referred by a friend please add their name so they get credit and earn an extra entry. Thanks for playing and good luck.
Your facebook username. We can not enter you without your username.
Your answer
Reffered by: Your friend will not get credit unless you put their username here.
Your answer
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