Telehealth Registration

/ Telehealth Registration

Telehealth Registration Form

Interested in booking a Plant Medicine consultation with a CDA Clinics specialist over the phone? Our telehealth service is available to any patient across the country. To begin your journey and book a telehealth consultation, the first step is to register below. Simply fill out the registration form to start the process. Once registered, you’ll receive and information pack containing everything you need to know before you book your consultation with CDA Clinics.

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

Step 2 of 4
Patient Email**
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Patient Phone Number old**
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*

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What is your primary condition diagnosis?**
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Other primary condition**
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How long has the condition lasted?**
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What are your primary symptom/s?**
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Other primary symptoms**
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Do you have any previous experience or knowledge of Medicinal Cannabis?**
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Which cannabinoids are you interested in discussing with our doctors?**
Extra Notes (Not Required)
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.
Form Completion*
- 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
Max. file size: 10 MB.
Attach Health Summary
Max. file size: 10 MB.
Attach Consent Form
Max. file size: 10 MB.
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 on a new page. Please wait for this before clicking submit again.
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Business Owner - Hidden
- CDA Clinics
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How It works

1. Register

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. Telehealth Consult

Once we’ve received a Referral and Health Summary from your Doctor, and a CDA Consent Form, you can book in for a consultation to explore treatment options.

Telehealth Patient Registration

Telehealth Registration Form

Step 1 of 4

Step 2 of 4

Step 3 of 4

Step 4 of 4

How It works

1. Register

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. Telehealth Consult

Once we’ve received a Referral and Health Summary from your Doctor, and a CDA Consent Form, you can book in for a consultation to explore treatment options.

3. Receive

If approved, gain access to the widest range of products, securely shipped to your door.