User Eligibility

Check if you're eligible for medical cannabis

Please enter a valid phone number in international format (e.g., +447911123456). Date of Birth

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Your Health Conditions

ADHD Agoraphobia Anxiety Appetite Disorders Arthritis Autistic Spectrum Disorder Back and Neck Pain Bipolar Bladder Pain Cancer Pain and Nausea Crohn’s Disease or Colitis Pain Chronic and Long-Term Pain Chronic Fatigue Syndrome (CFS) Cluster Headaches Complex Regional Pain Syndrome Depression Dermatology DVT Ehlers-Danlos Syndrome (EDS) Epilepsy Endometriosis Female Gynaecological Pain Fibromyalgia Irritable Bowel Syndrome (IBS) Migraine Multiple Sclerosis Pain and Muscle Spasm Nerve Pain OCD Osteoporosis Parkinson’s Disease Personality Disorder Phantom Limb Pain PTSD Sciatica Scoliosis Sleep Disorders Spondylolisthesis The Menopause Thalassemia Major Blood Disorder Tinnitus Tourette Syndrome Trigeminal Neuralgia Other Medical Condition

Prescription Check

I have been prescribed a medication for pain, sleep or mental health
(This can be a current or past prescription.) I have never been prescribed a medication.

Alfentanil Alprazolam Amitriptyline Atomoxetine Azathioprine Buprenorphine Bupropion Citalopram Clonazepam Codeine Codeine Phosphate Co-Codamol (30/500) Dexamfetamine Diazepam Diclofenac Dihydrocodeine Fentanyl Fluoxetine Fluoxetine (Prozac) Gabapentin Guanfacine Infliximab Lisdexamfetamine Lithium Lorazepam Melatonin Methylphenidate Meptazinol Methadone Methotrexate Mirtazapine Modafinil Morphine Naproxen Nefopam Nortriptyline Omeprazole Omezrapol Oxycodone Paroxetine Pentazocine Pethidine Prednisolone Propranolol Remifentanil Sertraline Sodium Valproate Suvorexant Tapentadol Temazepam Tramadol Trazodone Triazolam Venlafaxine Zolpidem Zopiclone Other Prescribed Medicines / Treatments

Address & Gender

Gender: Male Female Other

Medical History

Please describe in detail the medical condition(s)/problem(s) that you have received a diagnosis for.

Do you have a history of heart problems including palpitations, heart attack (MI), stroke, angina, chest pain, shortness of breath, arrhythmias, pacemaker, or taking any heart medications?

Yes No

Are you currently being treated for cancer or undergoing any cancer treatments?

Yes No

Are you currently taking Immunosuppressants or Immunotherapy medication?

Yes No

Do you have any history of Liver Disease including hepatitis, elevated liver enzyme function blood tests, fatty liver, cirrhosis?

Yes No

Psychiatric history - Have you ever been referred to a psychiatrist health service?

Yes No

Have You Ever Been Diagnosed With?

Mania (bipolar disorder) Schizophrenia Depression PTSD Anxiety Disorders (incl. GAD, OCD) Personality disorder Currently or previously suicidal None

Family History: Does anyone in your family suffer from any of the following conditions? (select all that apply)

Psychosis Schizophrenia Schizoaffective disorder Anxiety Depression Bipolar/Manic Depression/Mania None

Do you have any personal history of drug abuse or dependency?

Yes No

Do you have a history of alcohol abuse or dependency?

Yes No

Have you ever been under the care of drug and alcohol services?

Yes No

How many units of Alcohol do you drink per week?

Do you use cannabis to reduce or eliminate the use of any medications that have been prescribed for your medical condition?

Yes No

If you do use cannabis currently, how often do you use cannabis?

Every Day Every other day 1–2 times per week Never

How have you used cannabis?

Smoking (joints) Vaping Ingestion Topical Never

How much cannabis do you currently use per day?

Have you had any serious reaction to cannabis?

Please list current prescriptions and over-the-counter supplements (incl. any CBD oils/products):

Consent & Submit

Preferred Contact Methods: Email Phone SMS WhatsApp I confirm that the information provided is true and accurate. Upload Supporting Documents (in PDF file)

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