Register your details to receive information from us about the Medical Cannabis trials in Queensland

We are collecting information from people who are interested in hearing more about the Medical Cannabis trials in Queensland. Relevant information from the State Government, Health Professionals and Epilepsy Queensland will be passed on to you by email, in a timely manner.  We will endeavor to minimize the number of emails that you receive.
 
We will use global de-identified information from the survey, such as the number of families who seek information, to ensure the State Government is aware of the range of interest.
 
This survey is not requesting any medical or personal information beyond your contact details for the purposes of communication.  We will not share this information with third parties without your consent.
 
Epilepsy Queensland is endeavouring to play a supportive role for families with the Clinical Trials. We are not running the trials but will endeavor to get information to you about the trials as it comes to hand.

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* 1. What is your email address?

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* 2. What is your postcode?

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* 3. I am

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* 4. Description of epilepsy or seizure disorder:

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* 5. If you are interested in being in the trials, please tell us why:

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* 6. Name of epilepsy specialist (optional as we may wish to match interest with Specialists who want to play a role in the trial):

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* 7. What questions do you have about the trials that you would like to see in a Question-Answer document?

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* 8. What other information would you like to know about medicinal cannabis and epilepsy?

Thank you for completing this survey.  Please pass on this survey to any friend or health professional you believe would benefit from being informed about the trials in Queensland.

if you would like to discuss the survey or have any questions about epilepsy, please phone us on 073435 5000 or email epilepsy@epilepsyqueensland.com.au.

Epilepsy Queensland Inc
P O Box 1457 
Coorparoo BC 4151

www.epilepsyqueensland.com.au

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