By signing this document, you acknowledge that you have been informed of and undestand the following.
1. The medical practitioner, the clinic staff, and/or clinic representatives are neither providing nor dispensing medical marijuana.
2. Prior to your appointment, you are required to submit a copy of your most recent government issued photo ID.
3. The medical practitioner is evaluating you for the use of medical cannabis and will make their recommendation based in part, on the medical information you have provided. It is your responsibility to ensure that there is no misrepresentation of your medical information submitted in order for you to obtain a recommendation to use cannabis for your medical condition.
4. You agree to only use medical cannabis for the treatment of your medical condition as agreed upon by the physician and not for recreational or non-medical purposes.
5. The medical practitioner is addressing specific aspects of your medical care and, unless otherwise stated, is in no way establishing herself as your primary care physician.
6. Should the medical practitioner approve you for the use of medical cannabis, it is your responsibility to ensure that a renewal appointment is made one month prior to your expiry date. During your renewal appointment the physician will re-evaluate the possible continuance of cannabis.
7. You understand that it is your responsibility to stay informed regarding provincial and federal laws regarding the possession, use, sale/purchase and/or distribution of medical marijuana.
8. Marijuana is not recommended if you are pregnant or breastfeeding. If you think you may be pregnant or are thinking about becoming pregnant, speak with your Practitioner.
9. Health Canada, the medical practitioner and Green Card Canada clinic staff advise you that using cannabis is prohibited while driving or performing hazardous tasks such as operating heavy machinery. The same applies to safety-sensitive occupations such as health professionals and the supervision of children. Depending on dosage and administration, impairment can last over 24 hours following last usage.
10. The potential side effects from the use of marijuana include, but are not limited to the following; dizziness, anxiety, confusion, sedation, low blood pressure, impairment of short-term memory, euphoria, difficulty in completing complex tasks, suppression of the body’s immune system, inability to concentrate, impaired motor skills, paranoia, psychotic symptoms, general apathy, depression and/or restlessness.
11. Marijuana may exacerbate schizophrenia in persons predisposed to the disorder.
12. Marijuana use may also cause excessive talking and eating, alter your perception of time and space and impair your judgment.
13. You understand that using marijuana while under the influence of alcohol is not recommended. Additional side effects may become present when using both alcohol and marijuana.
14. Smoking marijuana may cause respiratory problems and harm, including; bronchitis, emphysema and laryngitis. In the opinion of many researchers, marijuana smoke contains known carcinogens (chemicals that cause cancer) and smoking marijuana may increase the risk of respiratory diseases and cancers in the lung, mouth and tongue. In addition, marijuana smoke contains harmful chemicals known as tars. If you begin to experience respiratory problems when using marijuana, you agree to stop using it and report your symptoms to a physician.
15. The medical practitioner and/or the Green Card Canada clinic staff will inform you of alternatives to smoking marijuana.
16. The risk, benefits and drug interactions of marijuana are not fully understood. If you are taking medication or undergoing treatment for any medical condition, you understand that you should consult with your primary care physician(s) before using marijuana and that you should not discontinue any medication or treatment previously prescribed unless advised to do so by your primary care physician.
17. Individuals may develop a tolerance to and/or dependence on marijuana. If you develop signs of withdrawal, which can include; feelings of depression, sadness, irritability, insomnia, restlessness, agitation, loss of appetite, trouble concentrating, sleep disturbances, and unusual tiredness, contact Green Card Canada staff.
18. Symptoms of marijuana overdose include but are not limited to; nausea, vomiting, hacking cough, disturbance in heart rhythm, numbness in hands, feet, arms or legs, anxiety attacks and incapacitation. If you experience these symptoms, you agree to contact your primary care physician, call 911 or go to the nearest emergency room.
19. If Green Card Canada subsequently learns that the information you have furnished is false or misleading, the recommendation by the physician for marijuana may be revoked. You agree to promptly meet the Green Card Canada staff and/or provide additional information in the event of any inaccuracies or misstatements in the information you have provided.
20. Recommendations made by the Green Card Canada about Licensed Producers, strains and methods of intake are recommendations ONLY. Green Card Canada reserves the right to discuss your information with your licensed producer and you agree with your licensed producer sharing information about your application and recommendation with Green Card Canada.
21. If you do not understand any of the above, you agree to contact Green Card Canada for clarification.
22. I authorize any Green Card Canada medical practitioner to make direct contact with a current, treating primary care physician to determine whether excessive use of marijuana has harmed myself, the patient.
23. I understand that the information I have been asked to provide to Green Card Canada and/or the medical practitioner is for the diagnosis and treatment of the medical condition(s) for which I want to access medical marijuana. I understand that if I have not accurately and completely disclosed the requested information, it may adversely impact the physician’s ability to diagnosis my condition and recommend appropriate medical marijuana treatment.