Minnesotans for Compassionate Care: Survey

Tell Your Story

If you're a medical marijuana patient or caregiver, we need your help.

We are looking for patients who could benefit (or are already benefiting) from medical marijuana and who would be willing to lobby
health and medical

Please fill out the information below so we can contact you. (Please leave any questions blank if you're uncomfortable answering them.) We will keep your information confidential, sharing it only with those for whom you give us permission.


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	State / Province: Required
*	ZIP / Postal Code: Required
	Phone Number:
	Remember me. What's this?

Question - Not Required - Please check the boxes indicating which conditions you suffer from:

	HIV/AIDS
	Cancer/chemotherapy
	Glaucoma
	Multiple sclerosis
	Epilepsy/seizures
	Pain
	Multiple/other

Question - Not Required - Please check all that apply:

	I am not a patient myself, but I am a caregiver for a patient.
	I am interested in testifying before the Minnesota Legislature.