Patient Form
1. Introduction
You have requested to enrol as a patient and to receive treatment at CBD Clinics Australia Pty Ltd.
This Patient Registration and Consent Form provides you with information about what your treatment may involve, including information about medicinal cannabis products which may be prescribed to you if it is clinically appropriate.
Please read this information carefully and ask questions about anything that you do not understand or want to know more about.
After reading this Patient Registration and Consent Form, you will be asked to sign the declaration and consent section. By signing it you are telling us that you:
- Understand what you have read.
- Consent to the use of your personal and health information as described here and in our Privacy Policy.
- Agree to comply with the terms and conditions specified in this Patient Registration and Consent Form and our Terms of Use.
If you do not want to proceed with your patient enrolment or treatment after reading this Patient Registration and Consent Form, or at any time, please let us know as soon as possible.
You will be given a copy of this Patient Registration and Consent Form to keep.
4. About CBD Clinics Australia
CBD Clinics Australia works with a number of Australian registered medical practitioners who specialise in treating patients with medical conditions who may benefit from medicinal cannabis.
5. What do I have to do?
You have requested to enrol as a patient and to receive treatment at CBD Clinics Australia Pty Ltd.
CBD Clinics Australia provides its services, including arranging patient consultations, through its website.
By signing this Patient Registration and Consent Form you agree to comply with the Terms of Use of CBD Clinics Australia’s website and online account system.
A copy of our Terms of Use is available here: https://cbdclinicsaustralia.com.au/terms-and- conditions/
6. What do I need to know about Medicinal Cannabis?
Most medicinal cannabis products are not generally available in Australia because they have not been evaluated by the Therapeutic Goods Administration of the Commonwealth Department of Health and registered on the Australian Register of Therapeutic Goods (ARTG). These are called ‘unapproved products’.
If it is clinically appropriate, you may be prescribed an unapproved medicinal cannabis product which can be supplied through the Special Access Scheme (SAS) or the Authorised Prescriber Scheme (APS). These schemes allow unapproved products to be legally supplied to some patients in circumstances where there is no alternative treatment available.
Before you sign this Patient Registration and Consent Form it is important that you understand:
a) The quality, safety and efficacy of unapproved medicinal cannabis products have not been fully assessed by the Therapeutic Goods Administration.
b) To the extent permissible by law, CBD Clinics Australia does not give any assurance as to the quality, safety and efficacy of any unapproved product you may be prescribed.
c) Your medical practitioner will discuss the potential benefits and risks of any specific product which your medical practitioner considers to be clinically appropriate before you commence treatment. This will include the known possible side effects however, with unapproved products, there may be side effects which medical practitioners are not yet aware of.
d) Supplying an unapproved medicinal cannabis product is likely to take longer than the supply of medicines which are registered in the ARTG.
e) Regular follow-up consultations are required to monitor ongoing treatment with an unapproved medicinal cannabis product.
f) Some medicinal cannabis products contain THC. THC can be detected in urine for many days after the last dose. It is a criminal offence to drive with THC in your body in every Australian state and territory. You will be advised whether this includes any particular product/s prescribed to you before you start treatment.
It is an offence in most Australian states and territories to possess any cannabis product, including a medicinal cannabis product, which has not been lawfully prescribed and/or supplied to you.
7. What will happen to information about me?
CBD Clinics Australia and its medical practitioners will collect your personal information, including some health information, in order to provide you with patient services and treatment. We will not disclose your information without your consent unless it is required or permitted by law. How we collect, use and disclose your personal information is described in more detail in our Privacy Policy.
A copy of our Privacy Policy is available here: https://cbdclinicsaustralia.com.au/privacy-policy/
By signing this Patient Registration and Consent Form you consent to CBD Clinics Australia collecting and using personal information and health information about you in accordance with our Privacy Policy.
8. Questions
If you have any questions about this Patient Registration and Consent Form you can contact CBD Clinics Australia at info@cbdclinicsaustralia.com.au.
9. Declarations and Consent
I have read this Patient Registration and Consent Form or someone has read it to me in a language that I understand.
I have had an opportunity to ask questions and I am satisfied with the answers I have received.
I freely agree to be a patient of CBD Clinics Australia as described and understand that I am free to withdraw my consent at any time.
I understand that I will be given a signed copy of this document to keep.
One of our friendly staff members will be in touch with you shortly.
Please make sure you can answer a private ID call.
If you miss it, don’t worry, we will call again during the same day.
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