|
Do you drink Alcohol?
|
If so, explain (how much, what, etc.)
|
|
Do you smoke Tobacco?
|
If so, how often (time/years, etc.)?
|
|
Have you been treated for substance abuse?
|
If yes, please explain.
|
|
Have you ever had surgery or broken bones?
|
If yes, please explain.
|
|
Are you allergic to any medications?
|
If yes, please explain.
|
|
Have you consulted other healthcare providers about your medical condition(s)?
|
If yes, please explain.
|
|
Have you ever used marijuana or CBD to treat your conditions?
|
If yes, please explain.
|
|
Are you prescribed medications?
|
If yes, please explain.
|
|
Please describe your current medical condition?
|
|
|
Tell us about your medical history.
|
|
|
Which of these conditions do you suffer from? Select all that apply.
• • •
|
|
