Preferred Method of Contact:*PhoneEmail
Are you seeking medical marijuana to treat symptoms caused by a motor vehicle accident, slip and fall, medical malpractice, workplace injury?YesNo
Province:*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaOntarioPrince Edward IslandQuebecSaskatchewanNorthwest TerritoriesNunavutYukon
Are you 25 years of age or older?*YesNo
Do you have a documented medical condition?*YesNo
Do you currently medicate with Cannabis?*YesNo
Are you a Veteran of the Canadian Forces:*YesNo
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