Skip to content
No Referral Required
Zenith
Clinics
Zenith
Clinics
Start pre-screening
About Us
Partners
White Label or Branded
Business
Patients
Contact
Menu
About Us
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 THC Flower Treatment (22% to 29% THC) – Two-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 22% THC Flower Trial
(Required)
DD slash MM slash YYYY
Current Medication and Treatment
How consistent were you in using 22% THC flower during the two-week trial?
Every day as prescribed
Most days
Occasionally
Rarely
What dosage of 22% THC flower were you taking during the trial?
Less than 0.5g/day
0.5-1g/day
0.5-1g/day
More than
How often did you use 22% THC flower?
Once a day
Twice a day
Three times a day
As needed
Symptom Management
What condition are you using THC flower to treat? (Select all that apply)
Chronic pain
Anxiety
Insomnia
Inflammation
Other (Please specify):
Please Specify
On a scale of 1 to 10, how effective has 22% THC flower been in managing your symptoms?
1-2
3-4
3-4
7-8
9-10
Have you noticed any changes in your symptoms since starting 22% THC flower?
Significant improvement
Some improvement
No change
Worsening of symptoms
Side Effects and Concerns
Have you experienced any side effects from using 22% THC flower during the trial? (Select all that apply)
Drowsiness
Dry mouth
Dizziness
Increased heart rate
Anxiety
None
Other (Please specify):
Please Specify
On a scale of 1 to 10, how manageable were these side effects
1-2
3-4
5-6
7-8
9-10
Did you have any concerns or issues with your THC flower treatment during the trial?
Yes
No
Tolerance and Efficacy
Do you feel you have developed a tolerance to the 22% THC flower?
Yes, significantly
Yes, somewhat
No, not really
Not at all
Was the 22% THC flower effective in treating your condition?
Very effective
Effective
Somewhat effective
Not effective
Do you feel the 22% THC flower was too weak in managing your symptoms?
Yes, definitely
Yes, somewhat
No, it was adequate
No, it was too strong
Breakout Pain and Acute Episodes
Have you experienced breakout pain or acute episodes that the 22% THC flower could not adequately control?
Yes, frequently
Yes, occasionally
Rarely
No
During these breakout pain or acute episodes, did you find the 22% THC flower insufficient in providing relief?
Yes, definitely
Yes, somewhat
No, it was adequate
No, it provided complete relief
Lifestyle and Preferences
How satisfied are you with the form of THC flower you used during the trial (e.g., vaporized, smoked)?
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied
Would you be open to trying a higher potency of THC flower (29%)?
Yes
No
Maybe
How important is it for you to have quick relief from your symptoms?
Very important
Important
Neutral
Not important
Overall Experience
How likely are you to continue using cannabinoid treatments as part of your treatment plan?
Very likely
Likely
Neutral
Unlikely
Very unlikely
How satisfied are you with the overall experience of using 22% THC flower during the trial?
Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied