JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
CBD Information Request
An inquiry for a Doctor's Recommendation
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Full Name
*
Your answer
City, State
*
Your answer
Telephone
Your answer
How did you find out about Healing Essence ?
A family/friend recommendation
A doctor's recommendation
Digital Media / Website Search
Other:
Clear selection
Have you tried products w/ CBD before?
Yes
No
Maybe
Which type of CBD products have you
tried
?
Topicals
Tinctures
Edibles/Cookies/Gummies
Capsules/Tablets
Vaporizer/CO2 Oil/Concentrates
Flower
Suppositories
What type of CBD products do you
prefer
?
Topicals
Tinctures
Edibles/Cookies/Gummies
Capsules/Tablets
Vaporizer/CO2 Oil/Concentrates
Flower
Suppositories
What would you consider your main reason for trying CBD?
Improved mood and mental health
Improved sleep and/or sleep habits
Improved mobility and wellness
Improved physical health and digestion
Relieve Pain and/or Inflammation
Clear selection
Are you using CBD to treat a specific health condition ?
Yes
No
Maybe
Clear selection
If yes (above), please describe below
Your answer
How long have you been using CBD in your health care choices?
Less than 1 month
Between 1 - 3 months
More than 3 months
More than 6 months
More than 1 year
Clear selection
How often do you use CBD products ?
In the evening only
1-2 times a day
1-2 times a week
Other
Clear selection
Do you have a preferred dose?
1-3mg
3-5mg
5-10mg
More than 10mg
Other:
Clear selection
Do you know about the book, CBD : a patient's guide to medical cannabis ?
Yes
No
Maybe
Clear selection
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
