Cannabis Use History Form
Please complete the Cannabis Use History Form to help us better understand your cannabis use patterns and related experiences.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
Current Cannabis Use Status
*
Currently using
Used in the past
Never used
How often do you use cannabis?
*
Please Select
Daily
Several times a week
Weekly
Monthly
Occasionally
Not currently using
What types of cannabis products have you used?
*
Flower/Bud
Edibles
Concentrates (e.g., wax, shatter)
Vape products
Topicals
Tinctures
Other
What is your primary method of cannabis use?
*
Smoking
Vaping
Eating/Drinking
Topical application
Other
What is your main reason or purpose for using cannabis?
*
Medical (symptom relief)
Recreational
Both medical and recreational
Other
Have you ever tried to stop or reduce your cannabis use?
*
Yes
No
Have you experienced any side effects or concerns related to cannabis use?
Additional notes or comments about your cannabis use history
Submit
Should be Empty: