Eligibility Test - CDA Clinics

Do you have a medical condition that has lasted more than 3 months?*
- YES
- NO
Have standard medicines failed to fully treat your medical condition or have you avoided treatments due to negative side effects?*
- YES
- NO
Have you avoided standard medicines due to side effects or potential side effects?*
- YES
- NO
It looks like you qualify for a plant medicine consultation. Would you like an information pack?*
- YES
- NO

You're eligible!

Now all you need to book a consultation is a referral and health summary from your regular Doctor. Please enquire below for an info pack
You're likely still eligible

Please enquire here and ask for a an eligibility screening over the phone.
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Patient's First Name**
Patient's Surname**
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Carer Full Name**
Carer Email**
Patient's Email**
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Patient Date of Birth**

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What is your primary condition diagnosis?**
Other primary condition**
How long has the condition lasted?**
What are your primary symptom/s?**
Other primary symptoms**
Do you have any previous experience or knowledge of Medicinal Cannabis?**
Which cannabinoids are you interested in discussing with our doctors?**
Extra Notes (Not Required)
How did you first hear about us?**
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Thank you for taking part in our eligibility screening.
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Are you eligible for a CDA Clinics Consultation?