Please confirm the following:
I am over the age of 18.
I am not currently pregnant, breastfeeding, or trying to conceive.
I do not have a history of schizophrenia, bipolar type 1 and 2 disorder or have experienced psychosis.
By ticking the boxes above, I confirm that I meet the stated criteria, and that the information provided is true and accurate to the best of my knowledge.
What are the main health issues or symptoms you’re seeking relief from?
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Chronic pain
E.g. arthritis, neuropathy.
Mental health concerns
E.g. anxiety, PTSD.
Sleep disorder
E.g. disturbance, insomnia.
Nausea or appetite loss
Other
Have you previously received treatment for your condition or symptoms?
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Yes
No
This may include conventional medicine, therapy, nutrition or alternative therapies.
How did you respond to your previous treatment(s)?
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I experienced symptoms or had unwanted side effects.
My symptoms were well managed without unwanted side effects.
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