I voluntarily agree to be treated with a medication namely < 1% Delta-9-Tetrahydrocannabinol which is not registered in South Africa.
I confirm that I have been fully informed and my questions answered about my disease (for which a section 21 application is being made), its cause, severity, prognosis, available (in South Africa) registered treatment options and the reasons for the current state of my illness and the unregistered medication and application to use a medication that is not registered in South Africa and that: