Follow-Up Appointment Questions

Tell us about your condition and any previous treatment to determine if alternative is right for you.

All your information is secure and confidential, so please be as open and honest as you can.

Please enable JavaScript in your browser to complete this form.

1. Are you happy with your current treatment plan?

2. Have you changed or started any other medications since starting your treatment?

3. Do you have and unwanted side effects or concerns with your current treatment plan?

Thank you, just one last thing!

Please share your email address and we'll share your results.

Name

First

Last

Phone Number

Date Of Birth

I am happy to hear from Canacare with new updated information regarding plant based medicine

I would like to receive emails from Canacare regarding the latest’s news and updates on plant based medicine

Do you read the Pravicy Policy?

I have read and fully understand the information in the Patient Consent Form.

By digitally signing this consent I acknowledge that this is the equivalent to my handwritten signature.

I have read and understood the consent form Canacare has provided in the link above.

I understand While using plant based medicine I will store it in a safe place out of reach from children and animals.

I will contact my doctor at Canacare if I have any questions or concerns regarding my plant based medicine treatment program.

Please sign below: