Follow Up Form

Patient Information

Sex
How long have you been a patient in the medical marijuana program?

Qualifying Condition

Qualifying Condition
Have you ever been diagnosed with any of the following?

Patient Questionnaire

1. Does the medical marijuana program meet your needs?
0/600 words
2. Has using medical cannabis improved your quality of life?
0/600 words
3. Have you been able to REDUCE any medications?
Select any medications you have reduced
0/600 words
3b. Have you been able to STOP TAKING any medications?
Select any medications you have stopped taking
0/600 words
4. What symptoms does medical cannabis help you with?
5. What dispensaries do you prefer?
What strains or products from Breakwater do you prefer?
 
What strains or products from Compassionate Care do you prefer?
 
What strains or products from Curaleaf do you prefer?
 
What strains or products from Garden State do you prefer?
 
What strains or products from Greenleaf do you prefer?
 
What strains or products from Harmony do you prefer?
 
6. What are your preferred methods of use?
 
Did you know you only inhale 25% of the cannabinoids that are smoked? Consider vaporizing. Ask a staff member to speak with an educator about vaporizing.
7. Have you experienced any side effects from cannabis such as
8. Are you interested in the following?
How would you rate the quality of service you receive at NJAM