Please read the following and sign below to indicate that you understand and acknowledge the information written.
1) Medical cannabis is used to treat debilitating medical conditions, defined as limiting life activities
2) The use of cannabis affects coordination and cognition, and impairs ability to drive or engage in potentially hazardous activities. Wait at least 6 hours after cannabis use before operating any equipment.
3) Some patients may experience symptoms when they stop using cannabis. These include irritability, insomnia, loss of appetite, restlessness, trouble concentrating and fatigue.
4) Cannabis potency varies with the strain and the method of consumption. Determining the appropriate cannabis dosage is difficult and may require a trial-and-error approach. Always start at the lowest dose and increase it gradually.
5) Nausea, palpitations and numbness are symptoms of cannabis excess. Chronic misuse of cannabis may lead to general apathy in some patients, or to psychosis in those who are predisposed.
6) Cannabis should not be used if you become pregnant or are breastfeeding.Possession of cannabis is still currently illegal under federal law. Your clinicians and staff are neither prescribing nor dispensing cannabis. Our certification is that a qualifying medical condition exists and that the potential benefits of medical marijuana appear to outweigh the risks.
7) Your clinicians and staff are addressing specific aspects of a patient’s medical care. Unless requested and established through formal acceptance into a clinical practice, they are in no way establishing themselves as a primary care provider. Anonymized responses provided in this form may be used to educate or for research purposes or to improve the quality of cannabis care that we provide.
8) Cannabis is not regulated by the Food and Drug Administration and may contain unknown quantities of active ingredients and impurities, although the state testing aims to minimize this possibility
9) Smoking cannabis (with flame) may cause respiratory illness, including cancer. Any ill effects experienced with the use of cannabis require discontinuation of the product and immediate medical evaluation.
10) A vaporizer substantially reduces many of the harmful toxins that are present in cannabis smoke. Avoiding flame use with cannabis is strongly recommended. Oral cannabis and topical preparations are known to be associated with fewer toxins.
11) We may periodically share communications, including via email, to provide updates on risks or relevant educational information, ensuring our patients remain informed and knowledgeable.
12) What is the refund policy?
Rescheduling - You may reschedule your appointment one time. Message us through the assistant (bottom right), or leave your phone number or email, and we'll help find a new time.
Transferring your evaluation - If you can't use your paid appointment, you may transfer it to someone else instead of rescheduling it yourself. Contact us with the new patient's information before the scheduled time.
Refunds - The evaluation fee is non-refundable under all circumstances, including cancellations, missed appointments, and evaluations where certification is not issued. Your one allowed reschedule, or the option to transfer your appointment to someone else, applies in place of a refund.
Missed appointments - If you miss your scheduled appointment, you may still use your one allowed reschedule to book a new time, provided you haven't already used it. The fee is not refunded.