This is a tool developed by SWC Arizona to help you monitor your use of medical marijuana and how your symptoms are affected by strain and dosage. Condition: _______________________________ Based on our rating scale what was your original level of symptom or pain prior to you starting Medical Marijuana? 1__2__3__4__5__6__7__8__9__10__ Based on our rating scale what is your present level of symptom or pain while taking Medical Marijuana? 1__2__3__4__5__6__7__8__9__10__ How to Rate your Symptom/Pain: Base your Self-Assessment Today on two factors. “The best you ever felt” is the symbol for how you feel!

Pain= No Pain
Cachexia= Normal Appetite
Seizure= No Seizure
Muscle Spasms= No Muscle Spasms
Agitation= No Agitation

“The worst you ever felt” is the symbol for how you feel!

Pain= Worst Pain Ever
Cachexia= No Appetite
Seizure= Worst Seizure Ever
Muscle Spasms= Worst Muscle Spasms Ever
Agitation= Worst Agitation Ever

Log

Frequency: record your self-assessment daily until you find a satisfactory medication level, then weekly or follow the recommendation of your Certifying Physician. We recommend discussing your dosing and experience with our Dispensary Agents during each visit.
Strains and Products: Record the strains or products you are taking. We have provided a space for the strain or product name, THC and CBD content if available.

Please visit us at SWC Tempe or SWC Prescott, or read our Patient Education materials, for additional educational information.

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