Medical Marijuana Strain Evaluation Form(s)

Since I typed up and posted this on another forum this morning, I thought I'd share it here, too, in case anybody found a need for it. :)

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Medical Marijuana Strain Evaluation Form
From Treating Yourself Magazine

Strain:
Breeder:
Grower:
Date:

Physical Examination

1. Visual Appeal, rate 1 (low) to 10 (high): 1 2 3 4 5 6 7 8 9 10

2. Visible Trichomes, 1 (none) to 10 (totally covered): 1 2 3 4 5 6 7 8 9 10

3. Colors present in trichome heads under magnification:
Clear ___ Cloudy ___ Amber ___ Dark ___

4. Colors present in buds, on 1-9 scale light to dark:
Brown ___ Green ___ Gold ___ Blue ___ Grey ___ Red ___
Rust ___ Orange ___ Purple ___ Black ___

5. Bud density, 1 to 10 (airy-dense): 1 2 3 4 5 6 7 8 9 10

6. Aroma descriptors, 1 to 9 on freshly broken bud (suble to pronounced):
Ammonia ___ Earthy ___ Licorice ___ Peach ___ Berry ___
Floral ___ Mango ___ Pepper ___ Blueberry ___ Fruit ___
Meat ___ Petroleum ___ Bubblegum ___ Grape ___ Melon ___
Pine ___ Cedar ___ Grapefruit ___ Menthol ___

7. Aroma, 1 to 10 (repulsive-delightful): 1 2 3 4 5 6 7 8 9 10

8. Seed content, 0-10 (none-fully seeded): 1 2 3 4 5 6 7 8 9 10

9. Weeks cured, if known:

Physical Examination Comments:

Usage

1. Utensils and method consumed:

2. Taste descriptors 1 to 9 (suble-pronounced):
Ammonia ___ Earthy ___ Licorice ___ Peach ___ Berry ___
Floral ___ Mango ___ Pepper ___ Blueberry ___ Fruit ___
Meat ___ Petroleum ___ Bubblegum ___ Grape ___ Melon ___
Pine ___ Cedar ___ Grapefruit ___ Menthol ___ Pineapple ___
Cherry ___ Grass/Hay ___ Mint ___ Rotten ___ Chocolate ___
Hash ___ Mold ___ Skunk ___ Citrus ___ Iron/Rust ___ Musk ___
Spice ___ Coconut ___ Leather ___ Nutmeg ___ Strawberry ___
Coffee ___ Lemon ___ Orange ___ Vanilla ___

3. Taste, 1 to 10 unpleasant-delicious: 1 2 3 4 5 6 7 8 9 10

4. State of dryness 1 to 10 (wet-dry) where 5 is ideal: 1 2 3 4 5 6 7 8 9 10

5. Smoke-ability, 1 to 10 (harsh-smooth), if applicable: 1 2 3 4 5 6 7 8 9 10

6. Smoke expansion, 1 to 10 (stable to explodes): 1 2 3 4 5 6 7 8 9 10

Usage Comments:

Follow-up Questions

1. Dosage to reach desired effect:

2. Effect onset, 1 to 10 (immediate-major creeper): 1 2 3 4 5 6 7 8 9 10

3. Sativa influence, 1-10 (head effect none to extreme): 1 2 3 4 5 6 7 8 9 10

4. Indica influence, 1-10 (body effect none to extreme): 1 2 3 4 5 6 7 8 9 10

5. Potency, 1-10 (none-devastating); 1 2 3 4 5 6 7 8 9 10

6. Duration of effect:

7. Tolerance build up, 1-10: 1 2 3 4 5 6 7 8 9 10

8. Usability, 1-9 (1 undesirable time to use, to 9 desirable time to use):
Morning/wake up 1 2 3 4 5 6 7 8 9
Day/work 1 2 3 4 5 6 7 8 9
Evening/relax 1 2 3 4 5 6 7 8 9
Night/sleep 1 2 3 4 5 6 7 8 9

9. Overall satisfaction, 1-10: 1 2 3 4 5 6 7 8 9 10

10. Ability and conditions (rate your own ability to judge): 1 2 3 4 5 6 7 8 9 10

11. Do you personally consider this strain a keeper for long term use? Y N

12. What effect did the strain have? Write "P" if positive and "N" if negative.
_____ Ability to rest or sit still
_____ Anxiety relief
_____ Appetite
_____ Audio perception
_____ Humor perception
_____ Imagination/creativity
_____ Pain relief
_____ Paranoia relief
_____ Sex drive
_____ Sleep
_____ Speech process
_____ Taste perception
_____ Thought process
_____ Visual perception

Extended Medical Survey, "P" for positive, otherwise leave blank:

_____ ADD/ADHD
_____ Allergic rhinitis
_____ Amphetamine dependence
_____ Anorexia
_____ Arthritis/musculoskeletar pain
_____ Asthma/cough
_____ Bipolar disorder
_____ Cancer/Chemotherapy
_____ Chronic fatigue
_____ Crohn's/IBS
_____ Depression
_____ Diarrhea
_____ Epilepsy
_____ Glaucoma
_____ Hepatitis
_____ High blood pressure/racing pulse
_____ Insomnia
_____ Itching
_____ Migraine/vascular headache
_____ Muscle Spasm
_____ Muscular movement disorders
_____ Nausea
_____ Panic Attack
_____ Peripheral nerve pain
_____ Post traumatic stress disorder
_____ Sedative/opiate dependence
_____ Schizophrenia
_____ Spasticity in multiple sclerosis

That is a nice form. I'd like to see something like that incorporated into this website that is simple and to the point so patients can evaluate what they want to try using. good job
You might contact the administrator and see if they can incorporate it.

Quote:

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Originally Posted by killerweed420

That is a nice form. I'd like to see something like that incorporated into this website that is simple and to the point so patients can evaluate what they want to try using. good job
You might contact the administrator and see if they can incorporate it.

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Since posting it, I found out it's almost word-for-word the same as what was used at one of the Cannabis Cups, and Treating Yourself yoinked it from there. Not sure about copyright issues and incorporating it into the forum here...