420 Culture Patient Information Form
  • Patient Information Form:

    (Personal Protection of Information Act 4 of 2013) Consent Form
  • *Kindly take note that 420 Culture will not share your personal information with any third party whatsoever.


    The reason for the below mentioned information is solely to formally register each research patient onto our Traditional Healing Programme and for 420 Culture Healing and its employees to adequately dispense applicable medication and products.

  • 420 Culture requires people who would like access to Medicinal Cannabis to become members of the 420 Culture Healing Programme in conjunction with the cultivators from facilities permitted under Section 22A(9)(a)(i) and Section 22C.

    The membership provides an opt-in to a private medicinal cannabis research group. The membership requires your agreement to receive communication regarding your correct medicinal use of cannabis and cannabis products. It also requires you to submit feedback data to the programme via occasional questionnaires.

    By becoming a member of this programme, you consent to your data being shared with the research body, to receive communication from 420 Culture and to submit information to the programme itself via occasional questionnaires and/or surveys.

    420 Culture Healing requires membership in order to verify among other issues that you are older than 18 years of age and what ailments you enter the Traditional Healing programme with. All access to medicinal Cannabis must be done in conjunction and after consultation with our medical health practitioners:
    T/DR R Perreira (Practice Number: 00012572/006)
    T/DR M Salie (Practice Number: 00012701/006)

    as registered with the African National Healers Association.

    The South African Cannabis laws are still in flux and the Constitutional Court ruling has created a framework for adult private use.


    420 Culture's Healing vision is to be compliant with all legislation and to be a business of integrity that offers high quality medicinal products from SAHPRA licensed growers with verifiable Quality Management Systems.


    Part of the philosophy of growth in the new industry is research.
    420 Culture, with its duly registered partners, is undertaking ongoing research to provide medically verifiable data. 

    Meanings:

    Confidential Information means any proprietary information delivered by one Party (the Discloser for the purposes of this definition) to the other (the Recipient for the purposes of this definition) pursuant to or in connection with this agreement. Material means Cannabis products or any form thereof and all natural products our Physicians are educated in.

    420 Culture Representations and Warranties:

    420 Culture (Herbal Healing) have:
    i) The requisite experience, knowledge and expertise;
    ii) Qualified personnel; and
    iii) The legal right to perform its obligations under this agreement.
    420 Culture will use commercially reasonable efforts to perform such obligations in a sound, safe, lawful and workmanlike manner.

    iv) 420 Culture, T/Dr R Perreira & T/DR M Salie acknowledge and agree that the material is only intended to be used for medicinal purposes in accordance with the Applicable Law of South Africa and 420 Culture and its representatives will only distribute the material to patients for medicinal purposes as required by the Applicable Law of South Africa.

    v) 420 Culture, T/Dr R Perreira, T/DR M Salie and our representatives acknowledge and agree that neither 420 Culture, its physicians nor any person on behalf has made or makes any express or implied representation, warranty or condition whatsoever, either oral or written, including any implied conditions or warranties of merchantability, fitness for a particular purpose, title, non-infringement or performance of material to standards specific to South Africa, whether arising by law, course of dealing, course of performance, usage of trade or otherwise, all of which are expressly disclaimed.
    Limitation of Liability:

    In no event shall 420 Culture, the Traditional Doctors, or any of its representatives be liable under this agreement or any third party for any consequential, indirect, incidental, exemplary, special or punitive damages whatsoever, including but not limited to any damages for business interruption, loss of use, data, revenue or profit, cost of capital, loss of business opportunity, loss of goodwill, whether arising out of breach of contract, tort, delict (including negligence), any other theory of liability or otherwise, regardless of whether such damages were foreseeable and whether or not 420 Culture or its representatives were advised of the possibility of such damages.

  • Declaration:

    I hereby declare that the above made statements are true and to the best of my knowledge and belief, and that I fully understand the information in this document:

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  • Medical Use / Product Acquisition Agreement

    Access cannabis for medical or research purposes from a Herbal Healing store.
  • I wish to become a member of the Herbal Healing Research Programme, in conjunction with 420 Culture.
    2024/017129/07

    As a member I agree to participate in the research of cannabis as a medicinal plant and other naturally grown medicinal plants.

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