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Medical Cannabis Pre-Screening Questionnaire

Eligibility & Safety Assessment

Thank you for taking the time to complete this pre-screening questionnaire.

The purpose of this assessment is to help determine whether you may be eligible for a medical cannabis consultation and to ensure that any potential treatment is safe, appropriate, and compliant with medical guidelines. Medical cannabis can be beneficial for certain conditions; however, individual health factors, current medications, and medical history must be carefully considered before proceeding.

The information you provide will be reviewed confidentially and used solely to:
  • Assess your preliminary eligibility for a medical cannabis consultation
  • Identify any potential risks, contraindications, or interactions
  • Support the prescribing doctor in making an informed clinical decision
Important: Completion of this questionnaire does not guarantee approval or prescription of medical cannabis. Final eligibility can only be determined during a consultation with a qualified healthcare practitioner.

Please answer all questions honestly and accurately. If you are unsure about any question, provide your best possible answer—this helps ensure your safety and the quality of care you receive.

What is your age range?

Why do we ask for your age?

Medical cannabis treatment is legally restricted to patients 18 years and older. This age requirement is mandated by law and helps ensure safe, responsible, and compliant access to treatment. Age verification allows us to meet regulatory requirements and protect patient wellbeing.

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Your information is kept confidential and secure.