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Services
About Us
Our Clinic
Our Team
Contact
Barbados
Pre Screening
Start Your Wellness Journey Online
Complete our quick pre-screening form to save time during your visit. It only takes a few minutes and helps us prepare personalized care tailored to your needs.
Pre Screening Form
General Information
Title
First name
(Required)
Last name
(Required)
Gender
Date of Birth
(Required)
Age
(Required)
ID / Passport Number
Contact Information
Cell Phone Number
(Required)
Address
(Required)
Email
(Required)
Other Information
Height
Weight
Relationship Status:
Married
Single
Other
Health insurance provider
Preferred Correspondence Language
Are you Local or Visiting?
Local Resident
Visitor
Do You Have an Interest in Medicinal Cannabis Products?
Yes
No
Medicinal Cannabis Pre Screen
Previous Cannabis Use:
Personal or family history of psychosis:
Current or past cannabis use disorder?
Active substance use disorder?
Any known cardiovascular disease?
Any known respiratory disease?
Currently pregnant or planning to become pregnant?