For Patients

Before we finalise your eligibility...
Permission 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 wellbeing.
Cost of medicine*
- I understand that cannabis-based medicine cost approximately £200 per month
Terms and conditions*
- I agree to the My Access Clinics terms and conditions and the privacy policy.
Patient type*
- 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.

Unfortunately, based on the information you shared, you don’t yet meet the criteria that would allow us to treat you with Medical Cannabis.

Why Am I Not Eligible?

Because Medical Cannabis can’t be prescribed as a 'first-line' treatment, you need to have tried a minimum of two treatments (licensed medications) prescribed by a doctor to manage the condition, both of which have provided inadequate relief.

What Should I Do Next?

Visit your doctor to discuss other first-line treatment options as a starting point.

How Can MyAccess Clinics Help?

We would be happy to reach out to you in another two months to see how you’re progressing. If you’d like us to do so, enter your contact details below.
Name*
First Last
Phone*
Please enter a valid UK phone number. It should start with 0 or +44, and be at least 11 digits long.
Email*

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
- I hold legal guardianship and have consent of the patient. If so, we will contact you 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*
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 ZIP / Postal Code
Best time to call and arrange a consult*
Name
This field is for validation purposes and should be left unchanged.

Before we finalise your eligibility...