For New Patients Returning Patient? CLICK HERE Your location(Required)Please select your treatment location UK Mainland (Including Isle of Man & Guernsey) Channel Islands (Jersey Only) Let's start by understanding your eligibility for an assessment by our clinic. *Please note, all questions are requiredMy condition is...(Required) Pain Psychiatric Neurological Gynaecological Pain Conditions - please select all relevant conditions(Required) Arthritis Cancer related pain Chronic pain Fibromyalgia Lower back pain Neuropathic pain Insomnia Mental Health Conditions - please select all relevant conditions(Required) Anxiety ADHD ASD PTSD Insomnia Neurological Conditions - please select all relevant conditions(Required) Migraines Cluster headaches Muscles Spasms Restless legs syndrome Neuropathic pain Stroke Spinal Cord Injury Epilepsy Parkinson's disease Alzheimer’s disease Chronic Fatigue syndrome Tourette Syndrome Others Gynaecological Conditions - please select all relevant conditions(Required) Pelvic Pain Endometriosis pain Menopausal symptoms Sleep disturbance To be eligible in the UK you are required to be under the care of a GP or specialist and have tried at least 2 other medications/treatments prescribed by your GP or specialist for the condition you are seeking support for.Please confirm that you have tried at least 2 other medications prescribed by a doctor, for your condition.(Required) Please tick Please confirm that your condition has been diagnosed by a doctor.(Required) Please tick Have you ever been diagnosed with Schizophrenia or Psychosis?(Required) Yes No The decision to prescribe for you, will be down to the specialist you see and the multi-disciplinary team. We aim to provide the best care for you, this may or may not include medical cannabis. Thank you. The information you've provided indicates you may be eligible for a consultation. Before we finalise your eligibility...Consent Checkboxes(Required) 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 wellbeing. I am over the age of 18 I confirm that I am aware of the costs associated my consultation with one of the MyAccess Clinic specialists. I confirm that I am aware that the cost associated with my ongoing treatment needs to be paid by myself. I agree to the MyAccess Clinics terms and conditions and the privacy policy. Patient Type(Required) I'm a patient I'm a carer or guardian of the patient 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
