I with this state that I fully understand the potential risks and side effects related to the use of cannabis and in using cannabis therapeutically, I accept full responsibility in assuming the risks and side effects related to its use. I understand there is no representation of the medical efficacy of marijuana by the doctor or the doctor's office staff. I agree to allow communication regarding my personal health information (PHI) via email and SMS from the medical group, which includes the doctor, the medical staff, the principals, the agents, and the employees. I understand that the doctor is NOT my primary care provider. I agree that the doctor and principals, agents, and employees, shall not be held responsible for any harm resulting to other individuals and me as a result of my medicinal use of cannabis. If I have legal issues about marijuana usage, I will consult with my attorney and law enforcement personnel. If I have work-related questions or concerns, I will consult with the Human Resources Department at my workplace immediately. With my signature, I acknowledge that I have read the above requirements and that I understand and agree with all of the statements mentioned above\.