Medical Forms

1)Do you suffer chronic pain (pain lasting longer than three months)?

Yes No

0 No Pain 10 Pain as bad as you can imagine

0% no relief 100% complete relief

0 does not affect sleep 10 keeps me up all night

0 No affect 10 Unable to walk and care for myself

0 Does not affect my mood 10 Severely impairs my mood

0 does not affect my work 10 severely impairs my work

0 I am able to socialise with my family and friends as often as I used to, 10 I completely avoid socialising because of pain

9) What is your current sleep routine? (Please tick applicable habits) Consistent nightly routine and sleep time Unplug from electronics 30-60 minutes before bed Get daylight exposure during the day Regular exercise Had 6-8 hours of uninterrupted sleep Wake up refreshed the next morning

The following questions are about your CONFIDENCE about the following items DESPITE your pain.

0 no confidence 10 extremely confident

12) Are you currently on Medicinal Cannabis treatment?

Yes No

If you answered “yes” to Q12, please complete the remainder of the inventory. Otherwise, thank-you for your responses.

13) What condition(s) are you taking medicinal cannabis for? (Please tick the relevant) Chronic pain (including osteoarthritis, lower back, joint pains) Insomnia PTSD Chemotherapy induced nausea and vomiting Palliative care Fibromyalgia Neuropathic pain Inflammatory bowel disease (Crohn’s disease, Ulcerative colitis) Psychiatric conditions (schizophrenia, bipolar disorder) Epilepsy Dementia Parkinson’s disease Autism Anorexia as an appetite stimulant Immune disorders Glaucoma Rheumatological conditions Multiple sclerosis AIDS related nausea and vomiting Tourette syndrome other, please state

14)In your opinion, are there any negative aspects of medicinal cannabis?

Yes No (if no, please go to Q16)

15) If yes, please tick which do you experience? It is expensive Weight gain Unable to concentrate/brain fog Makes me sleepy/sedation Dislike the smell of vaping/vaporiser Negative feedback from friends/relatives or medical practitioners who know I am on medicinal cannabis treatment Other reason, please state

16) Are you stopping medicinal cannabis treatment?

Yes No

17) If yes, what are your reasons for stopping medicinal cannabis treatment?

Brief Pain Inventory

The following questions are about your CONFIDENCE about the following items DESPITE your pain.

If you answered “yes” to Q12, please complete the remainder of the inventory. Otherwise, thank-you for your responses.