Veterancann Sign Up Form

Veterancann Sign Up Form
Are you an Australian Veteran? *
This service is available exclusively to veterans located in Australia. Unfortunately, you are not eligible to continue.
Name*

First NameLast Name
Phone*
Email*
example@example.com
Have you tried Medicinal Cannabis before?*
Are you a Gold card holder? *
Are you a white card holder? *
Do you have DVA-accepted conditions related to pain and/or injury? *
Unfortunately, You are not eligible for this service. If you would still like to become a patient please click Here to book a free consultation with one of our health professionals.
Book Your Appointment (Please be sure to change the time zone if necessary)*
Please note the number you will be contacted from is 03 7020 9153
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