Let’s start with a 30 second pre-screening.

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

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

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1. Firstly, do you have a medical condition that has been causing you distress for 3+ months? If yes, please list your symptom/s?
Please select your symptom/s that you wish to discuss with the Canacare doctor below:
2. How has your condition been treated up to now?”
3. Now a little more about your treatment. During your treatment, were you...
4. Are you pregnant or breastfeeding?
5. Have you ever had a history with psychosis or family history with psychosis?
Psychosis - a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality.
6. Have you ever had a drug addiction to prescription medication or on a drug replacement program?
Please share your email address and we'll share your results.
Name
I am happy to hear from Canacare with new updated information regarding alternative 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 alternative 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 alternative medicine treatment program.