Prescreen - 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
You may be eligible for a consultation with CDA Clinics. 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.
I'm**
Patient's First Name**
Patient's Surname**
Patients Gender**
Carer Full Name**
Carer Email**
Patient's Email**
Hidden
Phone old**
Phone**
Patient Date of Birth**

DD
MM
YYYY
State/territory**
Postcode**
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What is your primary condition diagnosis?**
Hidden
Other primary condition**
Hidden
How long has the condition lasted?**
Hidden
What are your primary symptom/s?**
Hidden
Other primary symptoms**
Hidden
Do you have any previous experience or knowledge of Medicinal Cannabis?**
Hidden
What are you interested in discussing with our doctors?**
Extra Notes (Not Required)
How did you first hear about us?**
Consent**
- I agree to the CDA Health and CDA Clinics Privacy Policy and Trading Terms & Conditions.
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Consultation Prescreen