Medical Cannabis Survey

Gender
 M F
Year of Birth
Date of Survey

1) Name of product evaluated
2a) Please indicate conditions for which you have used cannabis in an attempt to gain relief. Please check all that apply.
 Arthritis Cancer Chronic Pain Depression Chronic Fatigue Syndrome Fibromyalgia Glaucoma HIV/AIDS Migraine Multiple Sclerosis Nausea (Persistent) Neuralgia/neuropathy Neurological disorder Parkinson's disease Spasms (spasticity) Spinal Injury Wasting Weight Loss
2b) If you use cannabis for a different reason than above please specify.

3) How long have you been using cannabis for your medical conditions? Please select only one.
4) How often do you use cannabis? Please select only one.
5) How did this product affect your condition or symptoms overall? Please select only one.
6) What is your preferred method of using marijuana?
7) Would you purchase this product again?
 Yes No
8) Describe the effect this product produced overall? Please select as many as applies.
 Energetic Euphoric Happy Uplifted Anxious Dizzy Dry Mouth Dry Eye Creative Paranoid
9) How would you rate the potency of this product compared to other edibles of similar dosing?
10) How would you rate the period of onset of effects compared to other edibles?
11) Please review your experience. Anything else you would mention about using this product?
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