Patient First Program Evaluation Form

Clinic name
Medication
Number of units prescribed

Please rate this medication on a scale of 1 to 5, where 1 is low and 5 is high:
Q1: How satisfied are you with this medication in addressing your medical needs?
Q2: How would you rate your overall experience while taking this medicine?
Q3: How likely are you to continue treatment with the medication in the future?
Are there any challenges you encountered using this medication?
What symptom or condition are you seeking treating with this medication?
Other comments

While research into the efficacy and effects of plant-based medicines, including medicinal cannabis, for certain treatments is increasing, it is currently in its early days. Patients should always talk to a health professional for advice on their unique requirements before making any decisions about treatment options. For the latest, most accurate information on medicinal cannabis, head to the TGA website: https://www.tga.gov.au/medicinal-cannabis-guidance-documents

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PO Box 21 Balaclava 3183 VIC Australia

Contact:
1300 122 662
info@cannatrek.com

Cannatrek acknowledges the Traditional Owners and Custodians of the land on which we work and live, and recognises their continuing connection to land, water and community. We pay our respects to their Elders past, present and emerging.

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