New Patient Registration

/ New Patient Registration

Patient Registration Form

Begin your journey to accessing Endocannabinoid therapies by completing the registration form below. Once registered, you’ll receive and information pack containing everything you need to know before you book your consultation.

Step 1 of 4
Registration Type**
Patient's First Name**
Patient's Surname**

Step 2 of 4
Patient Email**
Patient Phone Number**
State/Territory
Postcode**
Carer Name**
If you are registering for someone else, you are the carer. Please provide your full legal name (first name and surname)
Carer Phone**
Consultation notifications are provided via SMS / Text Message. This will be used as the primary phone number
Carer Email**
Please provide your email address for consultation information, information resources and booking confirmations.

Step 3 of 4
Please provide a brief summary around the patients condition, length of condition/symptoms and any previous or current treatments/medications.
Patient's Gender**
Patient's Date of Birth

DD
MM
YYYY
Patient Notes**
How did you hear about us?**

Step 4 of 4
After this registration, the next step to access medicinal cannabis is a telehealth or in-clinic consultation with CDA Clinics. To book this consult, we will need:
- a referral letter from your GP
- a relevant health summary
- a consent form signed by you
If you don't have these forms yet, no problem - just tick the box below and we'll email you a copy of the forms to complete later. Otherwise please upload the completed documents below.
*
- I am yet to complete the forms
- I have completed the forms
Document Upload
Please tick the relevant boxes for the forms you have completed to upload them.
- Referral Letter
- Health Summary
- Consent Form
Attach Referral Letter
Attach Health Summary
Attach Consent Form
Consent**
- I agree to the CDA Health and CDA Clinics Privacy Policy and Trading Terms & Conditions.
* When you click submit, a submission confirmation will appear in a new browser tab. Please check this before submitting again.

How It works

1. Assesment

If you’re suffering from a chronic condition and seeking alternative methods with your regular GP to relieve symptoms and pain, register with CDA Clinics today.

2. Consultation

During your Telehealth or face to face consult in the clinic, we'll provide a customised treatment plan and the most suitable plant-based option for you.

Patient Registration Form

Step 1 of 4

Step 2 of 4

Step 3 of 4

Step 4 of 4

How It works

1. Assesment

If you’re suffering from a chronic condition and seeking alternative methods with your regular GP to relieve symptoms and pain, register with CDA Clinics today.

2. Consultation

During your Telehealth or face to face consult in the clinic, we'll provide a customised treatment plan and the most suitable plant-based option for you.

3. Treatment

CDA Clinics provide a range of natural therapy options, with medication securely shipped to your door. Our process is simple and easy!