Box of Jane Intake Survey
Survey 1
Email *
My Zip Code is _______ *
My Name is *
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
My favorite brand of rolling papers is
Clear selection
I wear formal business attire to work
Clear selection
My Box Code or Promo Code is (if applicable)
My Favorite Dispensary is
My Instagram Handle is (including @ )
Some of My Favorite Strains are
What else should we know?
A copy of your responses will be emailed to the address you provided.
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