Are you eligible?

What type of condition are you seeking treatment for?

This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Are you eligible?

Are you over 18 years old?

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This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Are you eligible?

Have you been prescribed at least two other treatments for your condition?

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This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Are you eligible?

Are you pregnant or breastfeeding?

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This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Are you eligible?

Have you ever been diagnosed with Schizophrenia, Psychosis or Bipolar Disorder?

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This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Unfortunately, you are not eligible for our treatment

The information you’ve provided indicates you are unlikely to be eligible for a consultation. Please get in contact if you would like to discuss your situation further.

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You are eligible!

Your details

Personal details

Please provide your details to receive pricing and information about the medicines we prescribe.

Please check your details are correct. We will never use this information to send you any unsolicited marketing or pass your details to any third parties.

This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Please complete all required fields.

Invalid entry, please check your details.

Your details

Patient type

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This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Your details

Terms & Conditions

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This form is NHS Data Security Compliant. Your data will be used exclusively by CB1 Medical to determine eligibility and will not be shared with any other party.

Thanks for submitting your details

We will be in contact within 24 hours. For further enquiries please contact 0116 273 1233 or email us at enquiries@cb1medical.com

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