United Ohio is seeking patients to meet with legislators and regulators to discuss your perspective on influence future legislation and regulations on Ohio's medical marijuana program.

Patients, if selected to participate, will receive a stipend for their time and travel to Columbus. Our Patient Coordinator will provide support and guidance to make sure you are prepared ahead of any meetings with legislators.

All patient information will be kept confidential. A Patient Coordinator will be in touch after completing the form.

Name *
Name
Phone
Phone
Status *
Are you able to travel to Columbus without assistance?
Availability *
Please specify what days you are most often available
Provide a brief overview of your situation, including condition that you would treat with cannabis, if a medical program existed in Ohio.