Patient Intake Questionnaire - Serenity Medical Marijuana: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information, including your name, address, and contact details. Ensure accuracy as this information is crucial for communication.
Indicate your age and occupation. This helps the medical team understand your background better.
Detail your current medical complaint and whether you are under a physician's care. If yes, provide the physician's name and contact information.
Answer questions regarding previous evaluations for medical marijuana and any relevant medical history, including medications and allergies.
Complete the informed consent section by reading each statement carefully and initialing where indicated to confirm your understanding of the risks associated with cannabis use.
Finally, review all entries for accuracy before signing the form at the bottom to confirm that all information provided is true.

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2015	4.8 Satisfied (86 Votes)

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