Greener Life Medical

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To begin, we ask that you please complete the patient intake form below. This form will help us assess your health history and understand your needs, and provides your consent to disclose personal health information.

The one-time administration fee (which will be invoiced upon booking) includes the initial consultation and unlimited access to the Greener Life aftercare program. 

 

 

  • Patient Form

  • Yes No 0-3 MONTHS 3-6 MONTHS 6-12 MONTHS > 1 Year
    Alcohol Dependency
    Alzheimer’s
    Anxiety
    Arthritis
    Asthma
    Bipolar Disorder
    Cancer
    Chronic Migraines
    Chronic Pain
    Concussion
    COPD
    Depression
    Diabetes - Insulin Dependent
    Diabetes - Non-Insulin Dependent
    Epilepsy
    Heart Disease
    Opioid Dependency
    Multiple Sclerosis
    Parkinson’s Disease
  • Yes No
    Concussion
    Fracture
    Infection
    Recent Injury
    Situational Anxiety
    Situational Depression
    Sprain
  • Yes No
    Kidney disease
    Heart disease
    Newly diagnosed mental health disease
    Previous substance abuse history
    Are you pregnant or breastfeeding?
    Are you under the age of 18?
    Previous severe adverse reaction to cannabis treatment

    If you answered “Yes” to any of these questions, please call us at 1-833-851-6431 to talk to an agent about your next step.

  • Yes No
    Cancer Pain Management
    Palliative Care
    Pain Greater Than 8/10
    Uncontrolled Neurological Symptoms (e.g. Seizures)
    Paediatric Patient (under 18 years of age)
    Autoimmune Disease