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Compassionate Cannabis Form

CCC Form

Name(Required)

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Gender(Required)

Date of Birth(Required)

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Email(Required)

personal Medical History(Required)

Personal Medical History(Required)

Other personal medical history that is not mentioned above (please specify:

Educational Level(Required)

Are there any vission problems that affects your communication?(Required)

Yes

No

Are there any hearing problems that affects your communication?(Required)

Yes

No

Are there any limitations to understanding or following instructions (either written or verbal)?(Required)

Yes

No

Consent(Required)

I agree to the privacy policy.

I understand that Cannabis is offered as treatment for specific medical conditions and/or symptoms as designated by the Texas Department of Health, Office of Compassionate Use. I understand that a Cannabis healthcare specialist is not implying or suggesting that cannabis should be a substitute for any other treatment prescribed by another physician. I understand that this certification does not enter me into the CURT System database. Cannabis is not regulated by the USFDA and therefore may contain unknown quantities of active ingredients, impurities, and/or containments. I am aware that cannabis has not been approved under federal regulations, and I understand that cannabis has not been deemed legal under federal law.

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OUR PROMISE OF COMPASSION

The best value that we promote is our compassion and integrity. We are here with you every step of the way in your medical journey to make sure that you are getting the best assistance and consultations for your money.

We understand your suffering and your needs. Your health is an investment we want to help develop. Whether it’s for pain relief, mental stability, or simply disease prevention we are committed to helping you with your own goals.

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NO JUDGMENT, PURELY COMPASSION

Judgment is the main hindrance to a good doctor-patient relationship and here at Compassionate Cannabis, we promote the three main ingredients to a great relationship according to American psychologist, Carl Rogers, that is to have Empathy, Honesty and Genuineness.

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COMPASSION WITH KNOWLEDGE

We work on a member-centered care system and take into account everything that you are feeling so we can provide the best solution for your needs. You may be saying we’re just selling on account of how much we care, but that is just an added value to the extensive knowledge that our professionals have. We consider everything as ever-changing and we commit to the growth of our professionals as well so we strive to be up-to-date on all of our practices without compromising the compassion we have devoted ourselves to.

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THE MISSING INGREDIENT

You might have done it all but it seems nothing works and that something important is missing. We have found that the missing ingredient – A good relationship based on care and not of pity will greatly relieve a member’s suffering–and we will strive to give this to everyone.