·GMC-registered specialists·No GP referral needed

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Initial eligibility check

Xen Health eligibility check.

This short questionnaire helps our clinical team understand whether you may be suitable for a consultation with one of our GMC-registered clinicians.

It takes about 2 minutes.

Eligibility Check

Section 1 — Basic eligibility

1. Are you 18 years or older?

Yes

No

2. Do you currently live in the UK?

Yes

No

3. Have you been diagnosed with a physical or mental health condition?

Yes

No

Currently seeking diagnosis

Section 2 — Condition information

4. Which condition(s) are you seeking support for?

Chronic pain

Anxiety

PTSD

ADHD

Insomnia / sleep issues

Depression

Fibromyalgia

Arthritis

Neurological condition

Gastrointestinal condition

Menopause symptoms

Cancer-related symptoms

Select all that apply.

Other condition (please describe)

Section 3 — Previous treatments

5. Have you previously tried treatments, medications, or therapies for your condition?

Yes

No

6. Approximately how many treatments have you tried?

1

2

3+

Unsure

7. Which types of treatment have you previously tried?

Prescription medication

Physiotherapy

Counselling / therapy

CBT

Alternative therapies

Lifestyle changes

Select all that apply.

Other treatment (please describe)

Section 4 — Medical safety screening

8. Are you currently pregnant, breastfeeding, or trying to become pregnant?

Yes

No

9. Have you ever been diagnosed with any of the following?

Schizophrenia

Psychosis

Schizoaffective disorder

Bipolar disorder

None of the above

Select all that apply.

10. Are you currently taking any prescription medications?

Yes

No

11. Do you have a history of substance dependency or addiction?

Yes

No

Prefer not to say

Section 5 — Cannabis experience

12. Have you previously used cannabis or CBD products?

Never

CBD only

Previously used cannabis

Currently using cannabis

Section 6 — Consultation readiness

13. Do you have access to your medical records or NHS Summary Care Record?

Yes

No

Unsure

14. Would you be comfortable attending a virtual consultation with a specialist clinician?

Yes

No

Contact details

Full name

Email

Phone number

Date of birth (DD/MM/YYYY)

Submitting this form does not guarantee eligibility or a prescription. All treatment decisions are made by specialist clinicians based on your medical history, current symptoms, and clinical suitability.

Xen Health consultations are conducted by GMC-registered clinicians in accordance with UK medical guidelines.

No payment · Reviewed by a clinician

Xen Health Clinics UK Limited · Company number 16379556 · Office 503, 332 Ladbroke Grove, London, W10 5AD · Mon–Fri 9–5 · hello@xenhealthclinics.co.uk · 020 4610 0816

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