Wellness Archives

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Red Pill Medical is a physician-owned company. We believed that CBD should be treated seriously like a medication when being used in patients who are on prescription medication and/or are suffering from chronic illness. We encourage you to let your primary treating physician and any other healthcare 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 and wellbeing. Once you submit this brief questionnaire, you will be contacted by email or phone to setup your consult. Please note the consult is FREE as we do not want cost to stand in the way of you getting pertinent information.
1. What is your age range?*
- 18-29
- 30-39
- 40-55
- 56-65
- 66 or more
2. Gender?*
- Female
- Male
3. Do you consider yourself overweight?*
- No
- Yes 5-15 lb overweight
- Yes 16-25 lb overweight
- Yes greater than 26 lb overweight
4. How often do you eat fast food?*
- Never
- Less than 3 times per month
- 1-2 times per week
- More than 2 times per week
5. Do you have problems sleeping?*
- Yes
- No
6. Do you have chronic low back pain?*
- Yes
- No
7. Do you have chronic joint pain?*
- Yes
- No
8. Do you have problems with anxiety?*
- Yes
- No
9. Do you get angry or lose control easily?*
- Yes
- No
10. Check off any of the following disorders you have:*
- Insomnia
- Migraine headaches
- Fibromyalgia
- Chronic fatigue
- High blood pressure
- Diabetes
- Depression
- Panic attacks
- Asthma
- Chronic pain
- Cancer or history of cancer
- IBS/Crohn’s/UC
- Hormone imbalances
- Addiction or history of addiction
- None of these
11. Check off any of the following types of medications you are currently on:*
- Antidepressants (e.g. Prozac, Effexor)
- Opioid painkillers (e.g. Norco, OxyContin)
- Anxiety pills (e.g. Xanax, Valium)
- Sleeping pills (e.g. Ambien, Lunesta)
- Muscle relaxants (e.g. Soma, Flexeril)
- Stimulants (Adderall, Ritalin)
- None of these
- I am on NO medications
12. Have you used medical marijuana before?*
- Yes
- No
13. Have you used cannabidiol (CBD) before?*
- Yes
- No
14. Check off any of the following disorders that run in your family history:*
- Insomnia
- Migraine headaches
- Fibromyalgia
- Chronic fatigue
- High blood pressure
- Diabetes
- Depression
- Panic attacks
- Asthma
- Chronic pain
- Cancer or history of cancer
- IBS/Crohn’s/UC
- Hormone imbalances
- Addiction or history of addiction
- None of these
15. Have you smoked cigarettes on a daily basis for:*
- 10 years or more
- 5-10 years
- Less than 5 years
- I do not smoke cigarettes
16. 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
17. Do you have any allergies to medications or nutritional supplements?*
- Yes
- No
If yes please list here:*
18. Choose the one of the following that best describes your overall health in your opinion;*
- Extremely healthy with no medical problems and not taking any prescription medications on a regular basis
- Good health with some minor medical problems and taking prescription medication on an as needed basis
- Fair health requiring daily prescription medications for medical problems
- Poor health, dealing with multiple medical problems and using more than 1 prescription medication on a daily basis
19. Are you currently seeing or have discussed any of these issues or conditions with your Primary Care Physician?*
- Yes
- No
- N/A
20. Are you currently seeing a Specialist for any of these issues or conditions?*
- Yes
- No
- N/A

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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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