The data we collect here will help us develop your treatment plan and should take 5 minutes. Any permissions given can be withdrawn at any time by emailing us and anything you share will never be shared with a third party.
Legally we have to inform you of current regulations around medical cannabis and its use in your treatment. We have also provided this information in your initial email.
I understand that the information I have been asked to provide is for the diagnosis and treatment of the medical condition for which I want to access that if I have not accurately and completely disclosed the requested information, it may adversely impact the physicians ability to diagnosis my condition and recommend appropriate medical cannabis treatment.
UK regulations require previous treatments to have been tried before medical cannabis can be legally prescribed.
Please upload a copy of your ID
Maximum file size: 50MB