Let's get started with some simple questions...
Go!
 
First Name: *

 
Last Name: *

 
Phone Number *

 
Postal Code: *

 
Date of Birth

 
Tell us why you think you're a good candidate for Medical Cannabis? *

Example: ADHD, Insomnia, Anxiety, Past Trauma, etc
 
Do you have documentation for your medical condition?

If no we may be able to assist
     
 
Where did you first see Campana Care? *

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