Questionnaire Questionnaire Please fill in your responses to the questions below. You will get a formulation recommendation and specific instructions on usage. Please check your SPAM folder for our response within 1 business day. Check all that apply to you: * Pain – General Pain – Localized Falling asleep Staying asleep Anxiety Digestion – Upper Digestion – Lower Autoimmune issue(s) Mental fog / Focus deficit PMS / Post-PMS / Hot Flashes Mood / Depression Blood sugar / Diabetes / Pre-diabetes Eczema / Psoriasis / Acne Which of those issues is/are the most important? Are you taking any medications? Have you tried cannabinoid medicine before? If so, what did you use, what dosage, and what were your results? Additional comments or details: Please provide your email so we can get back to you: * Name: * Contact Phone Number (to be used only if we can’t reach you via e-mail): * How did you hear about Trillium Botanicals? If you are human, leave this field blank. Send Δ
