Medical Cannabis Survey Sunshine Coast June 2021

Begin

Our Commitment: To assist our community in understanding when and how Medical Cannabis can help with medical and health-related issues.

Our Goal: To find out how we can assist our community with professional Medical Cannabis education and support from Trained Medical Cannabis Licensed Pharmacists, and when requested, to provide appropriate referrals to a network of Doctors specializing in Medical Cannabis.

Our Intention: To gather information in order to:

- Develop a patient-centered care strategy
- Assist those currently using Medical Cannabis to treat medical or health-related issues
- Assist those thinking about using Medical Cannabis to treat medical or health-related issues
- Provide valuable information from a Trained Medical Cannabis Licensed Pharmacist

Please fill out our quick & easy anonymous Medical Cannabis survey by clicking next below.

At the end of this survey, you’ll also be given an opportunity to provide your contact information – if you wish to have a private consultation with a Licensed Pharmacist trained in Medical Cannabis best uses, benefits, and potential interactions with prescribed medications.

*All information will be held in the strictest confidence.*

1

Are you an existing Medical Cannabis patient?

Yes

Do you have a Medical Cannabis document?

Yes

Are you currently a Recreational Cannabis user?

Yes

Have you considered using Medical Cannabis, but are not currently doing so?

Yes

2

Are you self-medicating with Recreational Cannabis for a medical or health-related condition(s)?

Yes

Do you suffer from pain or anxiety that is not currently being treated?

Yes

Have you previously or are you currently self-medicating with opioids?

Yes

Did you know that Medical Cannabis can be prescribed as an alternative to traditional medicine for treating conditions such as anxiety, depression, chronic pain, PTSD, migraines, depression and other conditions?

Yes

3

What medical or health 'symptoms' are you concerned about?

*Check all that apply:

Problems sleeping

General stress

Chronic physical pain

Depression

Acute physical pain

Migraines or headaches

Muscle spasms

Reduce prescribed medication(s)

Manage prescribed medication(s)

Other

Write any that apply to you (optional)

4

What medical or health 'conditions' are you seeking a cannabis prescription for?

Check all that apply:

Anxiety

Depression

Insomnia/trouble getting to sleep

Arthritis

Mental Health conditions

PTSD

Seizure disorders

Muscle spasticity

Other

Write any others that apply (Optional)

5

Are you currently taking medication(s) or herbal remedies?

Yes

If Yes, what medication(s), drugs or herbal remedies do you take or have you used?

Write Here

6

Do you use cannabis to reduce or eliminate medication(s) that have been prescribed by a Doctor for any medical or health-related condition(s)?

Yes

If Yes, please describe the medication(s) and the condition(s) below:

Write Here

7

Have you encountered any barriers to seeking Medical Cannabis?

Yes

If Yes, please describe below:

Write Here

8

Do you have any questions or concerns about using Medical Cannabis?

Yes

If Yes, please let us know what questions or concerns you may have?

Write Here

9

Are you aware that Medical Cannabis can interact with some medications, which could potentially lead to health complications?

Yes

Did you know that a Licensed Pharmacist trained as a Medical Cannabis Specialist can advise you on possible medication and drug interactions?

Yes

10

(Optional) Would you like to have a confidential conversation with a Licensed Pharmacist trained in Medical Cannabis uses, benefits and potential interactions with prescribed medications? If No, please click next.

Yes

If you answered ‘Yes’ to the above, please share your contact information below, and one of our Licensed Pharmacists will contact you as soon as possible.

* Your information will be held in the strictest confidence.

First Name

Last Name

Phone

Email Address

Best days & times to reach you?

Write Here

Almost Done

Please feel free to share this survey’s web address with anyone that may be interested in, may benefit from or would like to get more information on Medical Cannabis.

IMPORTANT: Please click on the ‘Button’ below to complete the survey.

Click Here to Complete Survey

Thank you for assisting us with this important survey.

Begin

1

2

3

4

5

6

7

8

9

10

Almost Done

Your form has been submitted