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Medical Card - (this is REQUIRED before we can proceed in creating your file)

Driver License or State ID - (this is REQUIRED before we can proceed in creating your file)

How did you hear about us?

What has your experience been so far with cannabis?

What is your Tolerence? Low 1: (10mg) - High 10: ( 100mg)
12345678910

What are you trying to get relief / help with?

Method of Consumption
Rosin-TorchRosin - EnailFlower -Joints or BluntsFlower -BowlsFlower- Vaporization, ie. VolcanoEdible -CapsulesEdible - FoodsEdible - Tincture)

Would you like to learn about the benefits of vaporization and maximizing both the medicinal value while allowing your medicine to last longer.
Yes, Please 🙂No, I'm GoodI am already on that level and know all about the dangers of off gassing and toxic elements.

Would you like to Pick up your things or have your items Delivery
PickupDelivery

Is there a local shop you would like to see @RoxiGray available at?

How can we be of an assistance?

Would like to take part in an education session on the who what when why and how of cannabis, ie RG101
YesNo

Would you be interested our monthly subscription box?
Yes, pleaseNo, thank you

Can we tag and Repost you in Social Media Posts?
Of CourseJust Make sure I look Good 🙂No Thank you, please dont share my posts or images