Missouri - Let's Get Started!
1
Are you a Missouri resident?
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2
Are you 21 or older?
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3
Have you been diagnosed with any of the following conditions?
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Anxiety
Cancer
Epilepsy
Glaucoma
Migraines
Persistent pain
Muscle spasms
Multiple Sclerosis
Fibromyalgia
Parkinson’s disease
Tourette’s syndrome
Psychiatric disorders including PTSD
Acquired immune deficiency syndrome (AIDS)
Dependence on prescription meds
A terminal Illness
Hepatitis C
Amyotrophic lateral sclerosis
IBS/Crohn’s disease
Huntington’s disease
Autism
Neuropathies
Sickle cell anemia
Alzheimer’s disease
Cachexia & wasting syndrome
Other chronic or debilitating condition
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4
What is your name?
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First Name
Last Name
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5
What is your email address?
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