Name: Schedule a Consult with a Physician (a la carte)
SKU: 5522
Price: 199.95 USD
Availability: InStock

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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?*

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:*

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:*

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:*

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

Schedule a Consult with a Physician (a la carte)

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