Name Are you interested in being contacted about the CMOS study being run by Applied Cannabis Research? Yes No Clinical Practice Details Type of medical clinic: * General Practice Multidisciplinary Clinic Specialist Clinic Practice Name * In which state is your medical practice? NSW QLD VIC SA WA TAS NT ACT Practice address * Postcode * Name of interested clinician (if applicable) Contact phone number * Email * Has your clinic prescribed medicinal cannabis products before? Yes No Comments / Questions *