I understand that the information I have been asked to provide to My Cannabis and/or associated healthcare professionals is to assist in developing treatment protocols for my medical condition(s) for which I would like to access medical cannabis as my main treatment option.
I understand that if I have not accurately and completely disclosed the requested information, it may adversely impact the healthcare professionals ability to evaluate my condition in order to recommend the appropriate medical cannabis treatment for my symptoms.
I confirm that the information in this intake form is accurate and completely filled out to the best of my ability.