Eligibility Form2 - Atlus

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Let’s start your journey by checking if you are eligible for treatment.

EXISTING PATIENTS

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Access the Atlus Knowledge Base and request appointment bookings.

Access specialist plant medicine care, from the comfort of your home at Atlus

Step 1 - Check your eligibility

Eligibility criteria for plant-based medicine may change time to time. Check your eligibility on the Atlus website.

Step 1 - Check your eligibility

Eligibility criteria for plant-based medicine may change time to time. Check your eligibility on the Atlus website.

Step 2 - Book a consultation

The initial consult is conducted by telehealth (audio) and involves taking a clinical history, reviewing past and current medication history and discussing plant-based medicine in further detail.

Step 2 - Book a consultation

The initial consult is conducted by telehealth (audio) and involves taking a clinical history, reviewing past and current medication history and discussing plant-based medicine in further detail.

Step 3 - Home delivery

If eligible, your plant medicine will be delivered to your door in a discreet box.

Step 3 - Home delivery

If eligible, your plant medicine will be delivered to your door in a discreet box.

By clicking “Agree” below you confirm you have read our Terms & Conditions and Privacy Policy.

Registration Form

This form will take about 4 minutes to complete.

To protect your personal information this form will clear and reset after 1 minute of inactivity.

"*" indicates required fields

Step 1 of 3

33%

Personal Details

Are you over the age of 18?*

Yes

No

Please confirm that you agree and understand that only the parent or legal guardian of the patient aged under 18 will be contacted in regards to arranging appointments and processing payments.*

I agree and understand

Register Your Eligibility

Are you suffering from a chronic condition? (a condition present for more than 3 months)*

No

Yes

Please share with us, what is your diagnosed condition?*

Have you been prescribed medication(s) for your condition?*

No

Yes

Did the medication(s) successfully control your condition or symptoms?*

No

Yes

Were you experiencing side effects on the medication(s)?*

No

Yes

Do you suffer from cardio or respiratory diseases? (heart and lung conditions)*

No

Yes

Do you have a history of psychosis or schizophrenia?*

No

Yes

Are you or have you ever been on the Opioid Treatment Program?*

No

Yes

Please be aware that further information may need to be provided to confirm your eligibility.

Are you pregnant, planning for pregnancy or breastfeeding?*

No

Yes

Hidden

Eligibility Score

Name*

First Name Last Name

Email*

Mobile Number*

Already have an account? Sign in

Cancel Registration

Access specialist plant medicine care, from the comfort of your home at Atlus

Step 1 - Check your eligibility

Eligibility criteria for plant-based medicine may change time to time. Check your eligibility on the Atlus website.

Step 1 - Check your eligibility

Eligibility criteria for plant-based medicine may change time to time. Check your eligibility on the Atlus website.

Step 2 - Book a consultation

The initial consult is conducted by telehealth (audio) and involves taking a clinical history, reviewing past and current medication history and discussing plant-based medicine in further detail.

Step 2 - Book a consultation

The initial consult is conducted by telehealth (audio) and involves taking a clinical history, reviewing past and current medication history and discussing plant-based medicine in further detail.

Step 3 - Home delivery

If eligible, your plant medicine will be delivered to your door in a discreet box.

Step 3 - Home delivery

If eligible, your plant medicine will be delivered to your door in a discreet box.

By clicking “Agree” below you confirm you have read our Terms & Conditions and Privacy Policy.

Registration Form

This form will take about 4 minutes to complete.

To protect your personal information this form will clear and reset after 1 minute of inactivity.

"*" indicates required fields

Step 1 of 3

33%

Personal Details

Are you over the age of 18?*

Yes

No

Please confirm that you agree and understand that only the parent or legal guardian of the patient aged under 18 will be contacted in regards to arranging appointments and processing payments.*

I agree and understand

Register Your Eligibility

Are you suffering from a chronic condition? (a condition present for more than 3 months)*

No

Yes

Please share with us, what is your diagnosed condition?*

Have you been prescribed medication(s) for your condition?*

No

Yes

Did the medication(s) successfully control your condition or symptoms?*

No

Yes

Were you experiencing side effects on the medication(s)?*

No

Yes

Do you suffer from cardio or respiratory diseases? (heart and lung conditions)*

No

Yes

Do you have a history of psychosis or schizophrenia?*

No

Yes

Are you or have you ever been on the Opioid Treatment Program?*

No

Yes

Please be aware that further information may need to be provided to confirm your eligibility.

Are you pregnant, planning for pregnancy or breastfeeding?

No

Yes

Hidden

Eligibility Score

Name*

First Name Last Name

Email*

Mobile Number*

Already have an account?

Cancel Registration

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Contact

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