You are less than 5 minutes away from fulfilling the documentation for a Medical Marijuana license. Cancer Disclaimer* There is insufficient evidence to support or refute the conclusion that cannabinoids are an effective treatment for cancers, including glioma. There is evidence to suggest that cannabinoids (and the endocannabinoid system more generally) may play a role in the cancer regulation processes. Due to a lack of recent, high quality reviews, a research gap exists concerning the effectiveness of cannabis or cannabinoids in treating cancer in general.
Epilepsy Disclaimer* There is insufficient evidence to support or refute the conclusion that cannabinoids are an effective treatment for epilepsy. Recent systematic reviews were unable to identify any randomized controlled trials evaluating the efficacy of cannbinoids for the treatment of epilepsy. Currently available clinical data therefore consist solely of uncontrolled case series, which do not provide high quality evidence of efficacy. Randomized trials of efficacy of cannabidiol for different forms of epilepsy have been completed and await publication.
Glaucoma Disclaimer* There is limited evidence that cannabinoids are an ineffective treatment for improving intraocular pressure associated with glaucoma. Lower intraocular pressure is a key target for glaucoma treatments. Nonrandomized studies in healthy volunteers and glaucoma patients have shown short-term reductions in intraocular pressure with oral, topical eye drops, and intravenous cannabinoids, suggesting the potentail for therapeautic benefit. A good-quality systemic review identified a single small trial that found no effect of two cannabinoids, given as an oromucosal spray, on intraocular pressure. The quality of evidence for the finding of no effect is limited. However, to be effective, treatments targeting lower intraocular pressure must provide continual rather than transient reductions in intraocular pressure. To date, those studies showing positive effects have shown only short-term benefit on intraocular pressure (hours), suggesting a limited potential for cannabinoids in the treatment of glaucoma.
Positive Status for HIV Disclaimer* There is limited evidence that cannabis and oral cannabinoids are effective in increasing appetite and decreasing weight loss associated with HIV/AIDS. There does not appear to be good-quality primary literature that reported on cannabis or cannbinoids as effective treatments for AIDS wasting syndrome.
AIDS Disclaimer* There is limited evidence that cannabis and oral cannabinoids are effective in increasing appetite and decreasing weight loss associated with HIV/AIDS. There does not appear to be good-quality primary literature that reported on cannabis or cannbinoids as effective treatments for AIDS wasting syndrome.
PTSD Disclaimer* There is limited evidence (a single, small fair-quality trial) that nabilone is effective for improving symptoms of posttraumatic stress disorder. A single, small crossover trial suggestes potential benefit from the pharmaceutical cannabinoid nabilone. This limited evidence is most applicable to male veterans and contrasts with non-randomized studies showing limited evidence of a statistical association between cannabis use (plant derived forms) and increased severity of posttraumatic stress disorder symptoms among individuals with posttraumatic stress disorder. There are other trials that are in the process of being conducted and if successfully completed, they will add substantially to the knowledge base.
Amyotrophic Lateral Sclerosis Disclaimer* There is insufficient evidence that cannabinoids are an effective treatment for symptoms associated with amyotrophic lateral sclerosis. Two small studies investigated the effect of dronabinal on symptoms associated with ALS. Although there were no differences from placebo in either trial, the sample sizes were small, the duration of the studies was short, and the dose of dronabinol may have been too small to ascertain any activity. The effect of cannabis was not investigated.
Crohn's Disclaimer* There is insufficient evidence to support or refute the conclusion that dronabinol is an effective treatment for symptoms associated with Crohn's.
Parkinson's Disclaimer* There is insufficient evidence that cannabinoids are an effective treatment for the motor system symptoms associated with Parkinson's disease or pain induced dyskinesia. Evidence suggests that the endocannabinoid system plays a meaningful role in certain neaurodegenerative processes; thus, it may be useful to determine the efficacy of cannabinoids in treating the symptoms of neurodegenrative diseases. Small trials of oral cannabinoid preperations have demonstrated no benefit compared to a placebo in ameliorating the side effects of Parkinson's diease. A seven-patient trail of nabilone suggested that is improved the dyskinesia associated with levodopa therapy, but the sample size limits the interpretation of the data. An observational study demonstrated improved outcomes, but the lack of a control group and the small sample size are limitations.
Multiple Sclerosis Disclaimer* There is substantial evidence that oral cannabinoids are an effective treatment for improving patient reported multiple sclerosis spasticity symptoms, but limited evidence for an effect on clinician measured spasticity. Based on evidence from randomized controlled trials included in systematic reviews, an oral cannabis extra, nabiximols, and orally administered THC are probably effective for reducing patient reported spasticity scores in patients with MS. The effect appears to be modest. These agents have not consistently demonstrated a benefit on clinician meausred spasticity indices.
Chronic Non-Malignant Pain Disclaimer* There is substantial evidence that cannabis is an effective treatment for chronic pain in adults. The majority of studies on pain evaluated nabiximols outside the United States. Only a handful of studies have evaluated the use of cannabis in the United States. and all of them evaluated cannabis in flower form provided by the National Institute on Drug Abuse. In contrast, many of the cannabis products that are sold in state-regulated markets bear little resemblance to the products that are available for research at the federal level in the United States. Pain patients also use topical forms. While the use of cannabis for the treatment of pain is supported by well controlled clinical trials, very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States.
HIV/AIDS Screening Questionnaire* Please check all that apply.
ALS Screening Questionnaire* Please check all that apply.
Cancer Screening Questionnaire* Please check all that apply.
Chronic Pain Screening Questionnaire* Please check all that apply.
Crohn's Disease* Please check all that apply.
Epilepsy Screening Questionnaire* Please check all that apply.
Glaucoma Screening Questionnaire* Please check all that apply.
Multiple Sclerosis Screening Questionnaire* Please check all that apply.
Parkinson's Screening Questionnaire* Please check all that apply.
Post-Traumatic Stress Disorder Screening Questionnaire* Please check all that apply.
Terminal Condition Screening Questionnaire* Please check all that apply.
Alopecia Areata Screening Questionnaire* Please check all that apply.
Alzheimer’s Disease Screening Questionnaire* Please check all that apply.
Ankylosing Spondylitis Screening Questionnaire* Please check all that apply.
Anorexia Screening Questionnaire* Please check all that apply.
Anxiety Screening Questionnaire* Please check all that apply.
Arthritis Screening Questionnaire* Please check all that apply.
Asthma Screening Questionnaire* Please check all that apply.
ADD/ADHD Screening Questionnaire* Please check all that apply.
Autism Screening Questionnaire* Please check all that apply.
Bipolar Disorder Screening Questionnaire* Please check all that apply.
Brain Trauma Screening Questionnaire* Please check all that apply.
Chronic Fatigue Syndrome Screening Questionnaire* Please check all that apply.
Chronic Obstructive Pulmonary Disease Screening Questionnaire* Please check all that apply.
Degenerative Disc Disease Screening Questionnaire* Please check all that apply.
Depression Screening Questionnaire* Please check all that apply.
Diabetes Type 1 Screening Questionnaire* Please check all that apply.
Diabetic Neuropathy Screening Questionnaire* Please check all that apply.
Diverticulitis Screening Questionnaire* Please check all that apply.
Dysphagia Screening Questionnaire* Please check all that apply.
Dystonia Screening Questionnaire* Please check all that apply.
Ehlers Danlos Syndrome Screening Questionnaire* Please check all that apply.
Gout Screening Questionnaire* Please check all that apply.
Graves’ Disease Screening Questionnaire* Please check all that apply.
Guillain-Barre Syndrome Screening Questionnaire* Please check all that apply.
Hashimoto’s Thyroiditis Screening Questionnaire* Please check all that apply.
Restless Leg Screening Questionnaire* Please check all that apply.
Rheumatoid Arthritis Screening Questionnaire* Please check all that apply.
Sjögren’s Syndrome Screening Questionnaire* Please check all that apply.
Social Anxiety Screening Questionnaire* Please check all that apply.
Stress Screening Questionnaire* Please check all that apply.
Tardive Dyskinesia Screening Questionnaire* Please check all that apply.
Tourette’s Syndrome Screening Questionnaire* Please check all that apply.
Ulcerative Colitis Screening Questionnaire* Please check all that apply.
Vitiligo Screening Questionnaire* Please check all that apply.
Huntington’s Disease Screening Questionnaire* Please check all that apply.
Hydrocephalus Screening Questionnaire* Please check all that apply.
Idiopathic Thrombocytopenic Purpura Screening Questionnaire* Please check all that apply.
Inflammatory Bowel Disease Screening Questionnaire* Please check all that apply.
Insomnia Screening Questionnaire* Please check all that apply.
Irritable Bowel Syndrome Screening Questionnaire* Please check all that apply.
Low Back Pain Screening Questionnaire* Please check all that apply.
Lupus Screening Questionnaire* Please check all that apply.
Muscular Dystrophy Screening Questionnaire* Please check all that apply.
Myasthenia Gravis Screening Questionnaire* Please check all that apply.
Neuropathic Pain Screening Questionnaire* Please check all that apply.
Obsessive Compulsive Disorder Screening Questionnaire* Please check all that apply.
Osteoarthritis Screening Questionnaire* Please check all that apply.
Pancreatitis Screening Questionnaire* Please check all that apply.
Peripheral Artery Disease Screening Questionnaire* Please check all that apply.
Assessment - Treatment Peripheral Artery Disease Diagnosis*
Cancer Diagnosis*
Chronic Pain Diagnosis*
Crohn's Diagnosis*
Epilepsy Diagnosis*
Glaucoma Diagnosis*
Multiple Sclerosis Diagnosis*
Parkinson's Diagnosis*
HIV Diagnosis*
PTSD Diagnosis*
Alopecia Areata Diagnosis*
Alzheimer's Diagnosis*
Ankylosing Spondylitis Diagnosis*
Anorexia Diagnosis*
Anxiety Diagnosis*
Arthritis Diagnosis*
Asthma Diagnosis*
ADD/ADHD Diagnosis*
Autism Diagnosis*
Bipolar Diagnosis*
Brain Trauma Diagnosis*
Chronic Fatigue Syndrome Diagnosis*
COPD Diagnosis*
Degenerative Disc Diagnosis*
Depression Diagnosis*
Diabetes Type 1 Diagnosis*
Diabetic Neuropathy Diagnosis*
Diverticulitis Diagnosis*
Dysphagia Diagnosis*
Dystonia Diagnosis*
Ehler-Danlos Syndrome Diagnosis*
Gout Diagnosis*
Grave's Disease Diagnosis*
Guillain-Barre Syndrome Diagnosis*
Hashimoto's Thyroiditis Diagnosis*
Restless Leg Syndrome Diagnosis*
Rheumatoid Arthritis Diagnosis*
Sjogren's Syndrome Diagnosis*
Social Anxiety Diagnosis*
Stress Diagnosis*
Tardive Dyskinesia Diagnosis*
Tourette's Diagnosis*
Ulcerative Colitis Diagnosis*
Vitiligo Diagnosis*
Huntington's Disease Diagnosis*
Hydrocephalus Diagnosis*
Idiopathic Thrombocytopenic Purpura Diagnosis*
Inflammatory Bowel Disease Diagnosis*
Insomnia Diagnosis*
Irritable Bowel Syndrome Diagnosis*
Lower Back Pain Diagnosis*
Lupus Diagnosis*
Muscular Dystrophy Diagnosis*
Myasthenia Graves Diagnosis*
Neuropathic Pain Diagnosis*
OCD Diagnosis*
Osteoarthritis Diagnosis*
Pancreatitis Diagnosis*
Anything else you would like to add?
Requested Date of Appointment* Please choose the date you'd like for your appointment. Please note we are open Monday-Thursday. (And closed the last Thursday of the month as well.) Please note the time is not guaranteed to be free.
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Requested Time of Appointment* Please choose the time you'd like for your appointment. Please note the time is not guaranteed to be free.
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Upload a Photo For your appointment, we will need to collect a photocopy of your current Driver's License or State ID with your current address on it. If you like you can upload the photo now to save time. If you have any other supporting documents you'd like to share you can add them here as well. This is not required.
You're done with this form, the only other thing you need to do after you submit the form with the button below is to go to our forms page here and print and fill out the Medical Marijuana Consent form. This form is required for your visit so doing it early will save you time!