Our team at canncura is pleased that you have decided to seek cannabis therapy from us. Together with our medical team, we would like to accompany and support you individually. In order to include you in our internal patient database, we require the information requested in this master data sheet. Your data will be treated with the utmost care and will only be accessible to our medical staff. Disclosure of any information is strictly prohibited within the framework of doctor-patient confidentiality.

Please make sure that your data is correct, as it must be identical to the data on your identity card/passport. Any medical documents, for example prescriptions, will only remain valid if the personal data match completely.

I hereby confirm that all my personal data is correct.

  •  kleinschreibung & Grosschreibung
  •  Nummer (0-9)
  •  Sonderzeichen (+-!@#$%^&*)
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