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Intake Form Test

Patient Intake Form (TEST VERSION)

Step 1 of 5

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  • Please note you must be 20 years or older to obtain a licence.
  • If you don't have an account please visit www.skype.com to register (phone or computer). For existing Skype users please add Skype username: Cannabis_Consulting
    Click Here for help finding your Skype ID
  • Unfortunately we are no longer able to accept patients from Newfoundland and Labrador. We apologize for the inconvenience
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  • Unfortunately we are no longer able to accept patients from Newfoundland and Labrador. We apologize for the inconvenience
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    Please check all that apply
  • Unfortunately we are no longer able to accept patients from Newfoundland and Labrador. We apologize for the inconvenience
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  • Unfortunately we are no longer able to accept patients from Newfoundland and Labrador. We apologize for the inconvenience
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  • HADS (Hospital Anxiety & Depression Scale) - Please read each statement below and choose the number which best describes how true the feeling is for you.
  • Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 256 MB.
  • Unfortunately we are no longer able to accept patients from Newfoundland and Labrador. You Will Not Be Able To Submit The Form. We apologize for the inconvenience
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