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Partners
White Label or Branded
Business
Patients
Contact
Start pre-screening
About Us
Partners
White Label or Branded
Business
Patients
Contact
Menu
About Us
Partners
White Label or Branded
Business
Patients
Contact
Patient Review Questionnaire for CBD Oil Treatment (2-Week Trial)
General Information
Hidden
Email
Hidden
Last Name
Name
(Required)
Age
(Required)
Gender
(Required)
Date of Visit
(Required)
DD slash MM slash YYYY
Start Date of CBD Oil Trial
(Required)
MM slash DD slash YYYY
Current Medication and Treatment
How consistent were you in taking CBD oil during the two-week trial?
(Required)
Every day as prescribed
Most days
Occasionally
Rarely
What dosage of CBD oil were you taking during the trial?
(Required)
Less than 10mg/day
10-20mg/day
20-50mg/day
More than 50mg/day
How often did you take CBD oil?
(Required)
Once a day
Twice a day
Three times a day
As needed
Symptom Management
What condition are you using CBD oil to treat? (Select all that apply)
(Required)
Chronic pain
Anxiety
Insomnia
Inflammation
Epilepsy
Other (Please specify)
Please Specify
On a scale of 1 to 10, how effective has CBD oil been in managing your symptoms over the two weeks?
(Required)
1-2
3-4
5-6
7-8
9-10
Have you noticed any changes in your symptoms since starting CBD oil?
(Required)
Significant improvement
Some improvement
No change
Worsening of symptoms
Side Effects and Concerns
Have you experienced any side effects from using CBD oil during the trial? (Select all that apply)
(Required)
Drowsiness
Dry mouth
Diarrhea
Fatigue
Changes in appetite
None
Other (Please specify):
Please Specify
On a scale of 1 to 10, how manageable were these side effects?
(Required)
1-2
3-4
5-6
7-8
9-10
Did you have any concerns or issues with your CBD oil treatment during the trial?
(Required)
Yes
No
Lifestyle and Preferences
How satisfied are you with the form of CBD oil you used during the trial (e.g., tincture, capsule, topical)?
(Required)
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Would you be open to trying different forms of cannabinoid treatments, including THC?
(Required)
Yes
No
Maybe
How important is it for you to have quick relief from your symptoms?
(Required)
Very important
Likely
Neutral
Unlikely
Very unlikely
How satisfied are you with the overall experience of using CBD oil during the trial?
(Required)
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied