Branchout Wellness Medical Cannabis Informed Consent

B. Nature of medicinal cannabis treatment

C. Assessment and suitability (clinical appropriateness)

I understand that my clinician will assess whether medicinal cannabis is appropriate for me and whether telehealth is appropriate for my circumstances. I may be asked to obtain additional information, attend in-person review, or provide records from other treating practitioners.

D. Potential benefits and limitations

I understand that potential benefits vary and may include symptom relief for specific conditions where evidence supports use. I understand there are limitations in the evidence base for some conditions and that response is not guaranteed.

E. Risks, side effects, and safety considerations

I have been informed of potential risks and side effects, which may include (but are not limited to): dizziness, drowsiness/sedation, dry mouth, impaired concentration, anxiety, mood changes, tachycardia/palpitations, gastrointestinal effects, impaired coordination, and potential interactions with other medicines. THC-containing products may increase the risk of impairment.

F. Pregnancy, breastfeeding, and minors

I understand that medicinal cannabis may pose risks in pregnancy and breastfeeding and may not be appropriate. If applicable, I have discussed pregnancy planning, pregnancy status, or breastfeeding with my clinician.

G. Driving, work, and legal obligations (Queensland)

I understand that cannabis can impair my ability to drive, operate machinery, or perform safety-sensitive work. Queensland has strict road safety requirements and there may be legal consequences for driving with THC present in my system, even if prescribed. I will not drive or operate machinery if impaired and will seek legal/clinical guidance as needed.

H. Product use, dosing, storage, and diversion risk

I understand that I must use the medicine exactly as prescribed, follow the titration schedule, and not share my medicine with anyone. I will store medicines securely away from children and others. I understand misuse or diversion may have legal and clinical consequences.

I. Monitoring, follow-up, and adverse event reporting

I understand that follow-up appointments are required to assess effectiveness, side effects, and ongoing suitability. I will report adverse effects promptly. Serious adverse events may require reporting to regulators as part of pharmacovigilance obligations.

J. Information sharing for prescribing and dispensing

I consent to sharing relevant clinical information with: pharmacies to dispense prescriptions; pathology providers; other treating practitioners; and regulators where legally required for monitored medicines and medicinal cannabis access pathways.

K. Telehealth limitations and emergency response

I understand telehealth has limitations compared with in-person assessment. In an emergency during a consultation, the clinic may need to contact emergency services (000) using my last known location to protect my safety.

L. Consent statement

By signing below, I confirm that: (1) I have read and understood this form; (2) my questions have been answered; (3) I understand the benefits, risks, alternatives, and legal obligations; (4) I consent to proceed with assessment and, if clinically appropriate, treatment with medicinal cannabis under applicable TGA pathways; and (5) I understand I can withdraw consent for treatment at any time by informing my clinician.

M. Clinician declaration

I have explained the proposed treatment, potential benefits and risks, alternatives, and relevant legal and safety considerations. I have provided the patient an opportunity to ask questions.