Do you or the person in your care have any of the following conditions? Chronic pain YesNo Neuropathic (nerve) pain YesNo Spasticity from neorological conditions (eg. MS) YesNo Parkinson's disease YesNo Cancer-related pain YesNo Chemotherapy-induced nausea and vomiting YesNo Anorexia (loss/lack of appetite) & wasting associated with chronic illness YesNo Problems with sleep YesNo Anxiety YesNo Depression YesNo Post-Traumatic Stress Disorder (PTSD) YesNo Refractory paediatric epilepsy YesNo Opioid addiction YesNo Palliative care indications (eg. sleep problems, pain, weakness, nausea, lack of appetite) YesNo Inflammatory Bowel disease such as Crohn's Disease, Ulcerative Colitis YesNo HIV/AIDS YesNo Severe Arthritis YesNo Fibromyalgia YesNo Alzheimer's disease YesNo Migraines YesNo My condition is not on the list but I am still interested in whether it might suit me YesNo Have you tried other medicine? YesNo Does your medicine have negative side effects? YesNo Do you want to be connected to a cannabis specialist doctor YesNo Would you like to apply for funding YesNo First Name Surname Email Phone
