Ireland Registration Form

Before your first consultation you will need to answer a series of eligibility questions.
 
If the answers below indicate that there is a good chance you could be eligible for treatment with Medicinal Cannabis, we will then seek your consent to access your medical records. If your potential eligibility is confirmed, we will arrange a consultation with one of our specialist doctors.
 
At this consultation, the Doctor will establish your eligibility for treatment with medicinal cannabis.
 
The doctor then presents your case to a multi-disciplinary team of specialists who are experts in the condition you are looking to be treated.
 
At this point, the MDT team and your prescribing Doctor will look at the best medication for your condition and process either your application on MCAP or application for Ministerial License.
 
Medicann will follow the process to its conclusion and once your application is approved your prescription will be written for your medication.

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* 1. Please enter your full details.

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* 2. What is your date of birth?

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* 3. Have you ever been diagnosed with schizophrenia or psychosis?

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* 4. Have you tried at least 2 other treatments for your condition, as prescribed by your GP or other specialist?

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* 5. What is the condition that you are looking to treat?

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* 6. How long have you had this condition? (months, years)

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* 7. What GP Practice are you registered with?

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* 8. What is your GPs name?

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* 10. Have you ever been referred to a specialist?

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* 11. Are you on the MCAT programme or have had a Ministerial licence granted now or in the past?

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* 12. Do you have any additional information you wish to add?

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