Name* First Last Email* Phone*Select a Condition*ALS (Lou Gehrig s Disease)AnorexiaAnxietyAny Terminal ConditionArthritisBack PainCachexia (Wasting Syndrome)CancerCrohn's DiseaseCyclical Vomiting SyndromeDiabetesEpilepsyGlaucomaHIV/AIDSHepatitis CIrritable Bowel Syndrome (with chronic abdominal pain)Lyme DiseaseMigraineMultiple SclerosisMuscle SpasmsMuscular DystrophyOther Debilitating Condition of Like, Kind, Or ClassParkinson's DiseasePost Traumatic Stress (PTSD)Severe & Chronic PainSevere NauseaSickle Cell AnemiaSpasticity I am currently a Florida Resident
