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Medical Cannabis Information Form
Fill the form to proceed to get the medical cannabis info/process.
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone
*
Your answer
Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Prefer not to say
Other:
Address
*
Your answer
Country
*
Your answer
Diagnosis / Condition
*
Alzheimer’s Disease
Anxiety
Appetite Loss
ADHD (Attention Deficity Hyperactivity Disorder)
ADD (Attention Hyperactivity Disorder)
Cancer
Crohn’s Disease
Chronic Pain
Depression
Eating Disorder such as anorexia
Epilepsy
Glaucoma
HIV / AIDS
Insomnia
Multiple Sclerosis (MS)
Muscle Spasms
Nausea
Pain
(PTSD) Post Traumatic Stress Disorder
Seizures
Required
Diagnosis / Condition (write here if your diagnosis is not listed)
Your answer
Recieved medical prescription other than medical cannabis for the condition?
*
Yes
No
Not sure
Please write your story about your condition/diagnosis: How has Norway failed to provide the right threatment for you?
Your answer
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