Medical Marijuana Treatment Clinics of Florida Patient Survey First name* Last name* Email* Phone*Conditions which may be eligible for a medical marijuana recommendation include but are not limited to: AIDS ALS (Lou Gehrig's disease) Alzheimer's Anxiety Arthritis Back Pain Cancer Cerebral Palsy Chronic Pain Crohn's Disease Degenerative Disc Disorder Diabetic Neuropathy Epilepsy Fibromyalgia Glaucoma Hepatitis C Herniated Disc HIV Irritable Bowel Syndrome (chronic) Lupus Lyme Disease Migraines Multiple Sclerosis Muscle Spasms Muscular Dystrophy Myasthenia Gravis Myositis Neuropathy Osteoarthritis Osteoporosis Parkinson's Disease Peripheral Vascular Disease Polymyalgia Rheumatica Post-Polio Syndrome Psychiatric Conditions PTSD (Post Traumatic Stress Disorder) Reflex Sympathetic Dystrophy Rheumatoid Arthritis RLS (Restless Legs Syndrome) Seizures Severe and Chronic Pain Sickle Cell Anemia Scoliosis Spasticity Spinal Stenosis Tourette's Ulcerative Colitis Another Debilitating Condition Your primary condition*Please select...AIDSALS (Lou Gehrig's disease)Alzheimer'sAnxietyArthritisBack PainCancerCerebral PalsyChronic PainCrohn's DiseaseDegenerative Disc DisorderDiabetic NeuropathyEpilepsyFibromyalgiaGlaucomaHepatitis CHerniated DiscHIVIrritable Bowel Syndrome (chronic)LupusLyme DiseaseMigraineMultiple SclerosisMuscle SpasmsMuscular DystrophyMyasthenia GravisMyositisNeuropathyOsteoarthritisOsteoporosisParkinson's DiseasePeripheral Vascular DiseasePolymyalgia RheumaticaPost-Polio SyndromePsychiatric ConditionsPTSD (Post Traumatic Stress Disorder)Reflex Sympathetic DystrophyRheumatoid ArthritisRLS (Restless Legs Syndrome)SeizuresSevere and Chronic PainSickle Cell AnemiaScoliosisSpasticitySpinal StenosisTourette'sUlcerative ColitisOther Debilitating ConditionIf other primary condition selected, enter below Additional condition*N/AAIDSALS (Lou Gehrig's disease)Alzheimer'sAnxietyArthritisBack PainCancerCerebral PalsyChronic PainCrohn's DiseaseDegenerative Disc DisorderDiabetic NeuropathyEpilepsyFibromyalgiaGlaucomaHepatitis CHerniated DiscHIVIrritable Bowel Syndrome (chronic)LupusLyme DiseaseMigraineMultiple SclerosisMuscle SpasmsMuscular DystrophyMyasthenia GravisMyositisNeuropathyOsteoarthritisOsteoporosisParkinson's DiseasePeripheral Vascular DiseasePolymyalgia RheumaticaPost-Polio SyndromePsychiatric ConditionsPTSD (Post Traumatic Stress Disorder)Reflex Sympathetic DystrophyRheumatoid ArthritisRLS (Restless Legs Syndrome)SeizuresSevere and Chronic PainSickle Cell AnemiaScoliosisSpasticitySpinal StenosisTourette'sUlcerative ColitisOther Debilitating ConditionIf other additional condition selected, enter below Have you received treatment for your condition?* Yes No Are you 21 or older?* Yes No Nearest location*Boca RatonBradentonCarrollwoodCasselberryFernandina BeachFort WaltonGainesvilleJacksonville BeachKissimmeeLakelandNaplesOcalaOrange ParkPalm HarborPanama City BeachPensacolaPort CharlottePort St. LucieSt. PetersburgSun CityTallahasseeTampa SouthThe VillagesWinter HavenHow did you hear about us?*Please select...Commercial (TV)Digital AdDispensaryEducation EventGetMyFloridaCard.comInternet SearchNewsNORMLPhysician ReferralPostcard or MailerPrint AdSaw a Clinic LocationSocial MediaTalk of the VillagesWeedmaps.comWord of MouthYelpYoutubeOtherDo you live in or have a residence in Florida?* Yes No If no, where is your residence?
