Box of Jane Intake Survey
Survey 1
Email address *
My Zip Code is _______ *
Your answer
My Name is *
Your answer
I have a medical marijuana recommendation *
Which Best Describes Your Experience Level? *
Required
I Enjoy the Following Aromas (select all that apply) *
Required
I Like the Following Flavors (select all that apply) *
Required
I am allergic to or dislike (select all that apply) *
Required
I Currently or Plan to Medicate before Beginning my Daily Routine *
On a Scale from 1 to 5, how Adventurous are you When trying New Foods? *
Not adventurous
Will try anything twice
I Medicate or Plan to Medicate in Order to *
Required
What are your preferred method(s) of medication *
Required
I use or plan to use cannabis as part of my diet and exercise routine *
I have taken a dab *
I am ____ years old
Your answer
My favorite brand of rolling papers is
I wear formal business attire to work
My Box Code or Promo Code is (if applicable)
Your answer
My Favorite Dispensary is
Your answer
My Instagram Handle is (including @ )
Your answer
Some of My Favorite Strains are
Your answer
What else should we know?
Your answer
A copy of your responses will be emailed to the address you provided.
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