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ADaPT Profile Evaluation 1.0
Thank you for taking the time and allowing me to ask these personal questions in order to provide you with a comprehensive, unique and adaptable cannabis profile. We will never share your data with any third party. Your privacy is very important to The UCCC.
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What is your name?
Your answer
What is your email address
Your answer
What is your age?
Your answer
What is your weight?
Your answer
Have you ever used cannabis before?
Yes
No
Clear selection
If yes, when, how and how often?
Your answer
If yes, what was/were your experience(s)?
Your answer
What is your overall current interest in cannabis education?
Your answer
Based on your current knowledge of the plant, how do you feel about cannabis as a medicinal product?
Your answer
Based on your current knowledge of the plant, how do you feel about cannabis as a recreational product?
Your answer
Do you feel that you currently have a “normal” eating schedule?
Yes
No
Clear selection
Do you feel that you currently have a “normal” sleeping schedule?
Yes
No
Clear selection
Do you have any major areas of recurring pain?
Your answer
Do you feel you experience some form of anxiety?
YES
No
Clear selection
Do you feel you have some form of depression?
Yes
No
Clear selection
Do you currently take medication that contains "consumption of grapefruit" warnings?
Yes
No
Clear selection
What smell or odor( s) do you relate to the following happiness?sadness?calmness?excitement?
Your answer
What tastes do you prefer when choosing your favorite dessert?
Your answer
If you drink alcohol, what would you consider your tolerance level?
Your answer
Do you have any occupational or religious limitations to consuming cannabis?
Your answer
What would you consider your monthly budget for cannabis purchases?
Your answer
What are your top 3 favorite fruits?
Your answer
What are your top 3 favorite spices?
Your answer
In a range from 1 to 5, where 1 is Not at All and 5 Extremely,
*
How hesitant are you to try cannabis?
1
2
3
4
5
N/A
What would you consider your main reason for wanting to try cannabis?
Your answer
Are there any other areas you would like to apply a cannabis regiment?
*
Your answer
Do you have any known allergies? If yes, please list.
Your answer
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