Medical Cannabis Sign Up

Email*

Tell us about your condition*

Have you previously tried at least two other licensed medications, treatments or therapies? *

Yes No

Have you, or an immediate family member, been diagnosed with psychosis or schizophrenia? *

Yes No

Are you transitioning from another medical cannabis clinic? *

Yes No

Are you currently a student, claiming benefits, or a veteran? *

Yes No

First name*

Last name*

Date of birth*

Phone number*

Gender*

Address

Please enter your address details below :

Address Line 1*

Address Line 2

Town or City*

County*

Postcode*

GP Private GP?

NHS number (optional)

(Find this on NHS letters, prescriptions, or the NHS app)

I authorize Iyos Pharmacy to access my Summary Care Record and any clinical letters related to any condition listed on my SCR, to process my application. *

I will provide proof of my veteran, student or means-based benefit status. *

I consent to being contacted regarding my treatment via email, phone, or SMS. *

I confirm I am aware there is a cost associated with the clinic consultations and medication I may be prescribed, and I agree to the Terms of Use *

Click here to read our Terms of Use.

Application Submitted!