Hello, I am a student at Arizona State University and am collecting information for my research paper. I have friends who use use both herbal and synthetic medications to help with various medical conditions and am writing my paper on this topic. I would very much appreciate your participation in this brief survey. Thank you. Your answers are strictly confidential and for this purpose only.

Norma

1. Questions about you:
a. What is your age?
___17 or younger ___ 18-30 ___ 31-44 ___45+older

b. What ailment are you suffering from?
___ AIDS ___Fibromyalgia ___Glaucoma ___Cancer

___ Other (please list)______________________________

2. What symptoms do you currently take prescription medication for? (Check any)

___Nausea ___Loss of Appetite

___Vomiting ___Weight Loss

___Leg pain ___Swelling

___Neck Pain ___Muscle Pain

___Migraines ___Seizures

___Insomnia ___Other___________________________

3. Have you ever considered discontinuing those medications due to the side effects?

___Yes ___No

4. Have you ever researched natural alternatives, such as marijuana or other herbs?

___Yes ___No

5. Thinking of the symptom you suffer the most from in question 2, how likely is it you
would use medicinal marijuana instead of chemical prescriptions if it were legal?

___Lease Likely ___Somewhat Likely ___Most Likely