Cannabis and Anxiety Interview Form

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Thank you for participating in the article about cannabis and anxiety. Your answers may be included in a special section in the MOD&ALT Health Magazine. Do not complete this form if you do not want to share your story. I will only use your initials and not your name. By completing this form you are giving Contessa Louise permission to publish your name and information you shared here. PLEASE ANSWER IN COMPLETE SENTENCES. I will copy and paste your answers. This Form must be completed by Wednesday, Aug 7th.

Your First & Last Name *

Your email address (so I can let you know if you used your story) *

How often do you smoke/ingest cannabis? *

Daily

Several times a week

A few times a month

A few times a year

Do you have a medical card or do you use it recreational? *

Medical

Recreational

Tell us about one time that you experienced anxiety while smoking or ingesting. Please use details. What was happening before? What happened during the anxiety attack? How did you resolve the feeling? *

How often do you experience anxiety when you smoke/ingest? *

Every time

Some times

Only that one time

Is there anything else you would like to add?

Submit

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