Medical Cannabis Survey

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.
ArthritisCancerChronic PainDepressionChronic Fatigue SyndromeFibromyalgiaGlaucomaHIV/AIDSMigraineMultiple SclerosisNausea (Persistent)Neuralgia/neuropathyNeurological disorderParkinson's diseaseSpasms (spasticity)Spinal InjuryWastingWeight 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?
8) Describe the effect this product produced overall? Please select as many as applies.
EnergeticEuphoricHappyUpliftedAnxiousDizzyDry MouthDry EyeCreativeParanoid
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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