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Please take 90 seconds and tell us a little about yourself

Red Pill Medical is a physician-owned company. We believe that CBD should be treated like a drug when being used in patients who are on prescription medication(s) and/or suffering from chronic illnesses. To ensure the best possible outcome for you, we need to collect some basic information about you and medical conditions that you may be suffering from. Your information will not be made public or shared with anyone. We encourage you to let your primary treating physician and any other health care or wellness professional you are seeing know that you are considering using or already using CBD. We welcome the opportunity to communicate directly with any of your providers so that everyone is on the same page regarding your health.
How did you hear about Red Pill?*
1) What is your age range?*
- 18-29
- 30-39
- 40-55
- 56-65
- 65 or older
2) Gender?*
We ask because CBD behaves differently in men and women.
- Female
- Male
3) Do you consider yourself overweight?*
- A little overweight
- Moderately overweight
- Obese
- I'm not overweight
4) How often do you have problems sleeping?*
- Occasionally
- Frequent
- Always
- Never
5) How often do you have aches and pains from working out or doing a physical job?*
- Occasionally
- Frequent
- Always
- Never
6) How often do you have trouble relaxing?*
- Occasionally
- Frequent
- Always
- Never
7) What is the level of stress at your job or in your home life?*
- Extreme
- Moderate
- Minor
- None
8) How would you rate your level of energy and stamina?*
- Very low
- Low
- Good
- Very good
9) How would you rate your sexual performance?*
- Very poor
- Poor
- Good
- Excellent
- I'm not sexually active
10) How often do you lack focus or concentration at work or school?*
- Occasionally
- Frequent
- Always
- Never
11) How often do you do a structured workout per week?*
Examples: Weight training, yoga class, running, etc
- Never
- 1-3
- 3-5
- Daily
12) How many times a week do you eat junk food?*
Examples: french fries, pizza, chips, cookies, candy, etc
- rarely
- 2-3
- Daily
- Never or no more than once per month
13) Are you currently pregnant or nursing?*
- Yes
- No
14) Do you currently work at a job (military, first responder, truck driver, etc.) that requires routine drug testing for?*
THC is the cannabinoid that causes the “high” with marijuana.
- Yes
- No
15) Choose any of the following natural supplements you take daily:*
- Vitamin D3
- CoQ10
- Vitamin C
- One a day multivitamin
- Ginkgo Biloba
- Ginseng
- Garlic
- Vitamin B12
- Glucosamine chondroitin
- Melatonin
- Valerian
- Milk thistle
- Alpha lipoic acid
- Turmeric
- Echinacea
- Green tea
- Ashwagandha
- Other
- I don’t take daily natural supplements
16) Do you have any allergies to medications or nutritional supplements?*
- No
- Yes
List any and all allergies to medication or nutritional supplements:*
17) Choose one of the following that best describes your overall health in your opinion:*
- Extremely
- Good
- Poor
- Very poor
FOOD AND DRUG ADMINISTRATION (FDA) DISCLOSURE: These statements have not been evaluated by the Food and Drug Administration (FDA). These products and statements are not intended to diagnose, treat, cure, or prevent any disease. The Food and Drug Administration (FDA) considers non-THC based hemp products to be "food based" and therefore legal without a medical marijuana license. As with any dietary or nutritional supplement you should consult your physician prior to starting any new supplement. Red pill products should not be used in lactating or pregnant women.

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FOOD AND DRUG ADMINISTRATION (FDA) DISCLOSURE: These statements have not been evaluated by the Food and Drug Administration (FDA). These products and statements are not intended to diagnose, treat, cure, or prevent any disease. The Food and Drug Administration (FDA) considers non-THC based hemp products to be "food based" and therefore legal without a medical marijuana license. As with any dietary or nutritional supplement you should consult your physician prior to starting any new supplement. Red pill products should not be used in lactating or pregnant women.

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