Patient Follow-up Form
Please answer all questions and hit SUBMIT at the bottom. This information is kept completely private.
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Have you had any bad reactions to the cannabis?
If you are female, are you currently pregnant, trying to get pregnant or breastfeeding?
This is a hotly debated issue! Limited good data is available for the safety of cannabis use while pregnant or breastfeeding. Unfortunately there is data that suggests it is not safe. For this reason, it is recommended that you not take the risk and avoid using it while pregnant or breastfeeding.
Legal Stuff - please read and acknowledge
Have you ever driven while under the influence?
More Legal Stuff - please read and acknowledge
Have have thoughts of harming yourself since starting cannabis?
If you currently feel suicidal, please call 911 or visit this link here for the National Suicide Prevention Lifeline
Have you had serious thoughts of harming others since starting cannabis?
If you currently feel homicidal, please call 911 or the National Crisis Hotline (1-800-273-8255) or visit this link here for SAVINGCAIN.org, a website dedicated to helping prevent murder.
Have you been seeing or hearing things others don't?
Almost done! Please check below any symptoms you're having right now.
Final Legal Stuff - please read and acknowledge
Click here if you would like to learn more about the potential negative effects of using marijuana products. There are many more resources, but this is a good place to start.

Contact

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Tel: 703-982-6300

Fax: 571-517-1184

me@AthenaHeals.com

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