Anfragen

Have you already got a prescription from us?

Yes No

Which symptoms or condition do you want to treat?

Palliative Care Chronic Pain Intestinal Disease Skin Disease Sleep Disorder Menstrual Complaints Cancer Neurological Disease Other diseases or symptoms

Where is the pain located?

Abdominal Pain Back Pain Joint Pain Headache Nerve Pain Other

What intestinal disease do you have?

Celiac Disease Crohn's Disease Ulcerative Colitis Irritable Bowel Syndrome Diverticulitis Other

Do you have pain?

Yes No Sometimes

What skin condition do you suffer from?

Pruritus Psoriasis Neurodermatitis Chronic wound healing disorders Other

What sleep disorders do you suffer from?

Difficulty staying asleep Difficulty falling asleep

Is your performance impaired by the sleep disorder?

Yes No

What menstrual disorders do you suffer from?

Menorrhagia (heavy menstrual bleeding) Dysmenorrhea (painful menstruation) Premenstrual Syndrome (PMS) Oligomenorrhea (irregular menstruation) Metrorrhagia (intermenstrual bleeding) Endometriosis Other

Do you have pain?

Yes No Sometimes

What type of cancer do you have?

Colon cancer Prostate cancer Lung cancer Skin cancer Leukemia Brain tumor Uterine cancer Breast cancer Other

Which stadium does your cancer fall under?

I: Localized cancer II: Locally advanced cancer III: Locally advanced cancer with lymph node involvement IV: Metastatic cancer

Are you currently receiving chemotherapy?

Yes No

What symptoms are you suffering from?

Loss of appetite Anxiety and restlessness Pain Nausea Other

Which neurological disease is it?

Multiple Sclerosis Polyneuropathy Chronic Migraine Muscle complaints Other

What symptoms are you suffering from?

Spasticity Anxiety and restlessness Movement restrictions Pain Loss of appetite Other

What type of illness is it?

Cancer Heart/Circulatory system Neurodegenerative Diseases Age-related Diseases Other

What is your main complaints?

Movement restrictions Loss of appetite Anxiety and restlessness Spasticity Pain Other

How strong is your pain?

Which description matches your pain best?

Pain attacks, painfree inbetween Pain attacks, pain inbetween Continuous pain with mild fluctuations Continuous pain with strong fluctuations

How long have you been suffering from your symptoms?

Less than 3 months 3 to 6 months More than 6 months

How strong is your pain?

Which description matches your pain best?

Pain attacks, painfree inbetween Pain attacks, pain inbetween Continuous pain with mild fluctuations Continuous pain with strong fluctuations

How long have you been suffering from your symptoms?

Less than 3 months 3 to 6 months More than 6 months

How much do your symptoms impact you?

Has your disease been diagnosed by a doctor?

Yes No

Did you try other treatment methods?

Yes No

Were the other treatment attempts successful?

Yes No Partially

Has cannabis been prescribed to you in Germany before?

Yes No

Did you face any of these side effects when consuming cannabis?

Dizzyness
Heart palpitations
Sleepiness
Circulatory Problems
Nausea
Increased Appetite
Motor Problems
Anxiety or Panic
Brain fog
Paranoia
Hallucinations
Memory Loss
Loneliness

Yes, I experience at least one of these side effects No, I don't experience any of these side effects

I confirm, that I don't meet any of the following criteria.

The disadvantages of your previous cannabis consumption outweigh the advantages
You have had a psychosis, schitzophrenic episode or other serious mental illness at least once in your life
You have severe cardiovascular disease, liver or kidney dysfunction, shortness of breath or lung disease
You suffer from severe depression with thoughts of harming yourself (suicidal)
In addition to your current symptoms, you have another chronic illness
You work as a car driver
You are allergic to cannabis

Yes, I confirm No, I don't

I confirm, that I don't consume any of these medications regularly.

Medicines to control blood pressure
Anticoagulant medicines such as Warfarin
Potency medicines such as Viagra
Sedative medicines such as Ativan, Valium, antidepressants and narcotics
Antidiabetics, blood thinners, anticonvulsants, antipsychotics, immunosuppressants, anticholinergics, sympathomimetics, psilocybin
CNS depressants such as benzodiazepines, barbiturates, opioids

Yes, I confirm No, I don't

I confirm, that I don't meet any of the following criteria.

You have committed crimes while intoxicated or to obtain drugs due to an addiction.
Unsuccessful attempt to stop cannabis consumption.
You have consumed cannabis despite causing physical or psychological problems.
You have consumed cannabis despite leading to neglect or other problems with family, friends or colleagues.
Cannabis consumption in risky situations, such as driving a car.
The need to consume more cannabis to experience the same high.

Yes, I confirm No, I don't

What illness do you suffer from?

What symptoms do you have?

Anxiety and restlessness Movement restrictions Loss of appetite Other

Please describe your complaints in more detail

Are you receiving medication for treatment?

Yes No

Unfortunately we cannot treat you

Based on your answer we unfortunately cannot continue this questionnaire, as treatment is not possible in your case. Please consult a doctor in person if you are experiencing symptoms.

Great news, you're eligible!

You can receive your online cannabis prescription for only €14.99

What happens next?

Your answers to our medical questionnaire indicate that you are eligible for an online cannabis prescription from our doctors. This will be automatically sent to the pharmacy after you order your flowers.