Please Check Each Box to Acknowledge You Have Read & Understand the Terms

PLEASE CHECK EACH BOX TO ACKNOWLEDGE YOU HAVE READ & UNDERSTAND THE TERMS

Violations of Cannaclinics code of conduct will result in a temporary or permanent termination of membership.

☐NO RESELLING NO SHARING. We provide medicinal cannabis for the sole use of qualified members. It is forbidden to resell or share of your prescription. An infraction will result in a permanent ban to purchase medicinal products from Cannaclinics.

☐ BE POLITE: We always do our best to provide superior service to our members. Please treat our staff and other members respectfully.

☐BE RESPONSIBLE: Please use your medicine in a respectful and responsible way. Please do NOT smoke cannabis on the street or premises.

☐KEEP US INFORMED. Please let us know about the quality of our products (positive or negative) and report any adverse effects. Your feedback is key to helping us meet your specific needs.

☐NEVER TRANSPORT CANNABIS PRODUCTS OUT OF CANADA.

☐IMPAIRMENT: Cannabis may cause a temporary decrease in coordination, cognitive abilities and short-term memory loss. Do not drive or operate heavy machinery while under the effect cannabis. Be especially careful of impairment when eating cannabis products or when using extracts. Do not eat cannabis products before swimming or driving.

☐ALCOHOL: Cannabis mixed with alcohol may cause vomiting and nausea. We recommend that you limit or stop intake of alcohol when under the influence of cannabis products.

☐IRRITATION: Always use harm reduction techniques to prevent respiratory irritation.

☐BLOOD PRESSURE: Initial increase in heart rate and/or blood pressure may be problematic for those with heart conditions or severe anxiety. Those taking digitalis or other cardiac medications should always use cannabis under careful supervision by a medical doctor.

☐WITHDRAWAL: There are no significant withdrawal effects when cannabis use is ceased or decreased. Some people experience minor restlessness, nausea and fatigue.

☐THE LAW: It is still illegal in Canada to possess, grow or distribute cannabis. Know your rights and take precautions to avoid the harmful effects of arrest, cannabis seizures, imprisonment and criminal record.

☐ I accept that Cannaclinics makes no guarantees or medical claims. I hereby agree for myself, my heirs and executors to waive any claims against Cannaclinics and its employees.

☐ I give consent to Cannaclinics to email me regarding news, events, and information (optional)

☐ I have read this form and agree to abide by the code of conduct and cautions listed above.

Name:______Signature:______Date:______

~ Please be respectful of other members and staff. The lounge is a member privilege. Cannaclinics staffs reserve the right to ask any member to leave without question. ~

~ There is a $50 fee to acquire a copy of your diagnosis from the naturopath. You will receive your first copy free by email only. DO NOT DELETE this email or you will be charged the $50 fee should you require another copy. ~