I understand that this Release and Acknowledgment contains IMPORTANT information about medical cannabis that the assessing physician requires that I acknowledge and understand before he/she may issue a prescription and/or authorization for use of medical cannabis.
I further understand that the consulting physician will not necessarily be assuming care for me. He/She will, however, assess and evaluate the appropriateness of my request to use medical cannabis to assist in treating the conditions and associated symptoms that I believe; from my own personal experience, medical cannabis to be helpful in treating.
I accordingly confirm that the assessing physician will be my medical practitioner for the sole purpose of medical cannabis authorization and/or prescriptions.
I agree not to make any claim or commence any legal proceedings against the assessing physician, his/her practice, my family physician or any other involved physicians (such as specialists) in relation to:
1. my use of cannabis as a medicine; and
2. my Application or, prescription for possessing, obtaining and using medical cannabis.
I am well aware that physicians generally agree that medical cannabis;
• May distort perception (sights, sounds, touch, time);
• May impair memory and learning
• May impair coordination
• May impair thinking and problem-solving
• May increase heart rate and reduces blood
• May produce anxiety, fear, distrust or panic.