I declare the following to be true:
- I am at least 19 years of age
- I am aware cannabis is not an approved as official therapeutic agent in Canada, despite thousands of years of use by the Indigenous Nations of the Americas.
- I believe that cannabis and cannabis therapy may be useful medicine to combat the scourge of alcohol and addiction that has devastated First Nations peoples since the beginning of colonization.
- I wish to consider the use of cannabis as medicine despite potential side effects.
- I have a medical condition (diagnosis) that may benefit from cannabis.
- I am full capable of making informed healthcare choices for my own person.
- I respect all First Nations treaties and believe that cannabis is a plant medicine that can be produced and sold by all First Nations who are interested and able. This right is protected by treaty in Canada and worldwide by United Nations declarations on the rights of Aboriginal peoples.
- I agree not to make any claim or commence any proceedings against Headz.ca, any First Nations, any family physicians, or any other involved physicians in relation to my use of cannabis or any cannabis products.
- I do not support any claims made by my family, friends or other interested parties against said Headz.ca ca and physicians. I release Headz.ca, any First Nation, my family physician, and any other involved physicians from any and all actions, claims, causes of actions, complaints (even by family and friends) and demands for damages, loss, or injury whatsoever arising directly or indirectly as a consequence to my use of cannabis or any cannabis products. This release from liability is to be binding on heirs, executors and assigns.
SIDE EFFECTS CONSENT (I declare the following to be true)
- I acknowledge there has only been limited research into the safety of cannabis and that the safety and efficiency of dried cannabis for medical purposes has not been established. No notice of compliance has been issued for cannabis in Canada. I understand and accept the following possible consequences of cannabis use including but not limited to: impaired judgment, anxiety, paranoia, sedation, decreased inhibitions, drug tolerance, possible dependence, possible withdrawal symptoms, the need for possible drug holidays, an increase in appetite leading possibly to weight gain, an impaired immune system, interaction with other drugs, the possible need to decrease the dose of some medications (with the supervision of my primary care physician,) dysphoria (an unpleasant emotional state,) depleted energy, impaired short term memory, and lung damage (smoked form.)
- I acknowledge that all the potential health risks associated with cannabis may not yet have been identified and that cannabis may have an adverse effect on my health in the future.
- I acknowledge the use of cannabis may influence my motor skills. Consequently, I will not operate a motor vehicle, handle machinery or perform other activities where impairment may cause injury if impaired with any cannabis products.
- I understand that the use of cannabis may be harmful to the unborn during pregnancy. I agree to notify my primary care giver about my use of cannabis if pregnant.