Cannabis in Your Community
Please take a few minutes to tell us more about you and your preferences
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Please share your email address
*
example@example.com
What is the zip code of your primary residence?
*
What is your gender?
*
Female
Male
Non-binary
Transgender
Prefer not to answer
What is your race?
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White
Black or African American
Native American/ Indigenous or Alaska Native
Native Hawaiian or Pacific Islander
Asian
What is your age range?
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0-17
18-24
25-34
35-44
45-54
55-64
65+
What is your ethnicity?
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Hispanic or Latino
Non Hispanic/ Latino
Do you have children?
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Yes
No
Which would best describe cannabis?
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Drug
Medicine
Are you in support of recreational cannabis
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Yes
No
Are you in support of medical cannabis?
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Yes
No
Are you in support of cannabis being sold on Mesilla Valley Pharmacy premises?
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Yes
No
Are you in support of cannabis being sold on Mesilla Valley Pharmacy premises, even though they directly share a wall with a school?
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Yes
No
Would you be in support of another dispensary, not ran by pharmacists, selling cannabis within 300ft of the school?
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Yes
No
Are you aware there is another dispensary approved within the same 300ft radius to the school?
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Yes
No
Are you aware that there is a restaurant that serves alcohol and beer within the same 300ft radius to the school?
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Yes
No
Do you use cannabis, either recreationally or medically?
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Yes
No
Do you currently take any medications?
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Yes
No
Has a healthcare professional ever talked to you about the interactions of cannabis and medications you are taking?
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Yes
No
Would you be willing to sign a petition in support of our pharmacy selling cannabis?
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Yes
No
Would you be willing to write an email/ letter in support of our pharmacy selling cannabis?
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Yes
No
May we contact you using the email and/ or phone number you provided at the beginning of this survey?
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Yes
No
Which form of communication would you prefer?
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Email
Phone
Either
Submit
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