top of page

Please Complete The Medical Pre-Screening Assessment

PERSONAL DETAILS

Gender
Date of Birth
Year
Month
Day

PATIENT'S HEALTH REVIEW

Do you have any prior experience with cannabis use?
Yes
No
Have you ever had a negative experience with cannabis use?
Yes
No
Do you or any member of your family have a history of mental illness?
Yes
No
Do you have a history of or currently have active psychosis?
Yes
No
Do you have a history of or currently have active bipolar disorder?
Yes
No
Do you suffer from severe or unstable cardio-pulmonary disease?
Yes
No
Are you currently pregnant?
Yes
No

ELIGIBLE QUALIFYING CONDITIONS

Tell us about your current condition:

Disclaimer: 

Island Therapeutics Inc. is required by law to manage a cannabis registry for verification of qualified patients and their primary caregivers who are authorized to possess, transport, and/or use medical cannabis within Barbados. Participation by patients and primary care givers in this registry is voluntary. All information provided is treated as confidential as stipulated in section 27(1) of the Medicinal Cannabis Industry Act 2019.

I confirm that all medical information provided is true and complete to the best of my knowledge. I understand that providing false or misleading information may impact my eligibility for treatment and the appropriate use of medicinal cannabis.

bottom of page