Age Range
<18
18-24
25-34
35-44
45-54
55-64
65+
Gender
Male
Female
Prefer not to say
Prefer to specify
Frequency of use
Experienced / Daily
Regular (A few times a week)
Occasional (A few times a month)
Rarely (Every few months)
New user (Little to no prior experience)
Medicinal User
Frequency and Dosage for medicinal purpose
Primary reason for use
Recreational / Social
Medicinal / Therapeutic
Wellness / Relaxation
Spiritual / Creative
Preferred consumtion methods
How do you typically consume cannabis? (Please check all that apply)
Smoking (flower, pre-rolls)
Vaping (cartridges, dry herb vaporizers)
Edibles (gummies, baked goods, drinks)
Oils / Tinctures (sublingual drops)
Topicals (creams, balms)
Other (Please specify)
Dispensary
Layla & Tayla
Lil Jamaica
CannaAfrica
Time of Use:
When do you typically use cannabis? (Please check all that apply)
Morning (for daytime symptom relief)
Afternoon
Evening / Before bed (for relaxation or sleep)
As needed for acute symptoms
Desired Therapeutic Effects:
What are the main therapeutic effects you are hoping to achieve with cannabis? (Please check up to three)
Pain relief
Anxiety reduction
Improved sleep
Mood elevation
Increased appetite
Reduced inflammation
Muscle relaxation
Other (Please specify)
THC Strain & Type Preference:
Do you have a preference for certain types of THC-dominant cannabis strains? If so, please explain why (e.g., for energy, relaxation, focus).
THC/ Sativa-dominant strains (e.g., Durban Poison):
CBD/ Indica-dominant strains (e.g., Purple Punch, Venom OG):
Hybrid strains (e.g., Mimosa, Girl Scout Cookies):
I am unsure or have no preference.
Positive Effects Noticed:
Please describe any specific positive effects or symptom relief you have experienced from particular cannabis strains or products you have used in the past.
Adverse Effects:
Have you ever experienced any negative or unwanted side effects from cannabis use? (Please check all that apply)
Anxiety or paranoia
Drowsiness or fatigue
Dizziness or lightheadedness
Dry mouth / eyes
Impaired concentration or memory
Increased heart rate
None
Other
Current Medications:
Please list all other prescription medications, over-the-counter drugs, and supplements you are currently taking. This is crucial for identifying any potential interactions.