For Doctors

Let’s start by understanding your patient’s eligibility for an assessment by our clinic.
My patient's condition is ...*
- Generalised Anxiety Disorder (GAD)
- Pain, Neuropathic Pain or Chronic Pain
- Post-Traumatic Stress Disorder (PTSD)
- Sleep Disorder
- Attention Deficit Hyperactivity Disorder (ADHD)
How many approved (licensed) medications have you been prescribed so far for the condition?*
To be eligible the patient needs to have been prescribed 2 licenced medications.
Which of these approved (licensed) medications has your patient been prescribed so far for their condition?*
- SSRI: Fluvoxamine, Fluoxetine, Paroxetine, Escitalopram, Citalopram or Sertraline
- SNRI: Venlafaxine, Duloxetine
- Pregabalin
- Quetiapine
- Benzodiazepine
- Propranolol
- Other
Which of these approved (licensed) medications has your patient been prescribed so far for their condition?*
- Diclofenac (common brand name: Voltarol)
- Capsaicin
- Clonidine
- Epidural injections of local anaesthetic or steroid
- Gabapentin
- Naproxen
- Opioids such as Codeine, Tramadol, Buprenorphine, Morphine and Fentanyl
- Prazosin
- Pregabalin
- Propranolol
- SNRI such as Duloxetine and Venlafaxine
- Topiramate
- Valproic Acid
- Other
Which of these approved (licensed) medications has your patient been prescribed so far for their condition?*
- Venlafaxine
- SSRI: Sertraline, Fluoxetine, Paroxetine
- Risperidone
- Proporanolol
- Duloxetine
- Quetiapine
- Aripiprazole
- Paliperidone
- Other
Which of these approved (licensed) medications has your patient been prescribed so far for their condition?*
- Promethazine (Common brand name: Phenergan Night Time)
- Benzodiazepines such as Temazepam, Loprazolam, Lormetazepam, Diazepam and Nitrazepam
- Zaleplon
- Zolpidem
- Zopiclone
- Other
Which of these approved (licensed) medications has your patient been prescribed so far for their condition?*
- Atomoxetine
- Guanfacine
- Methylphenidate
- Dexamfetamine
- Lisdexamfetamine
- Other
Other medication*
Number of prescribed medications

Before we finalise your eligibility...
Permissions to store*
- I give MyAccess Clinics permission to store and use the information I share in this form to communicate with me, and to care for my patient's wellbeing.
Terms and conditions*
- I agree to the My Access Clinics terms and conditions and the privacy policy.
You can withdraw your permission at any time by contacting ukprivacy@myaccessclinics.com

Any information you share with us in this form will never be shared with a third party.

Step 1

Step 2
Based on the information you have provided us so far, your patient is eligible for an assessment. Let’s continue with some contact details.
Contact Details*
- The contact is a patient
- The contact is a carer or guardian of the patient
Carer or Guardian Details
In all other cases, we’ll need to speak directly to the patient. If they have any difficulty communicating, please give us guidance on the best time to call them if you’d like to be present to assist them.
Legal guardianship
- There is a carer who holds legal guardianship of the patient. If so, we will contact that person directly
Carer/ Guardian Name*
First Last
Carer/ Guardian Email*
Carer/ Guardian Phone*
Please enter a valid UK phone number. It should start with 0 or +44, and be at least 11 digits long.
Patient Details
Name*
First Last
Email*
Phone Number*
Please enter a valid UK phone number. It should start with 0 or +44, and be at least 11 digits long.
Address*
Street Address Address Line 2 City Postcode
Best time to call and arrange a consult*

Step 1

Step 2
Your details
Name*
First Last
Your GMC Number*
Not sure how to find your GMC number? Go here to search for it
Medical Practice name*
Your phone number*
Please enter a valid UK phone number. It should start with 0 or +44, and be at least 11 digits long.
Your email*
Contacting the doctor*
- I consent to MyAccess Clinics contacting my patient directly to arrange a consult.
Form is correct*
- I confirm all information I have provided in this form is correct

Unfortunately, based on the information you shared, your patient doesn’t yet meet the criteria that would allow us to treat them with Cannabis-based products for medicinal use (CBPM).

Why Are TheyI Not Eligible?

Because CBPM can’t be prescribed as a 'first-line' treatment. Your patient needs to have been prescribed and tried a minimum of two treatments (licensed medications) to manage the condition, both of which have provided inadequate relief.

What Should I Do Next?

Speak with your patient to discuss other first-line treatment options as a starting point. For more information on prescribing, go here.

How Can MyAccess Clinics Help?

We would be happy to reach out to you and discuss this patient should you have any questions. If you’d like us to do so, enter your contact details below.
Name*
First Last
Email*
Comments
This field is for validation purposes and should be left unchanged.

Before we finalise your eligibility...

Carer or Guardian Details

Patient Details

Your details

Why Are TheyI Not Eligible?

What Should I Do Next?

How Can MyAccess Clinics Help?