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Physician Guided Terminal Illness Assistance Program (PGTIAP)

Please carefully read the terms and conditions regarding this program. In order to participate in this three-month program, very specific conditions must be met. 

  1. Speak with your primary physician and obtain their consent to participate with you in this program.

  2. Review and print off the PGTIAP application, Terms and Conditions (TC), Release of Liability (ROL) documents, and the SRI Mental and Physical Health Status Assessment Survey (MPHSAS). 

  3. Fill out the TC document and both you and your physician agree to and sign the document.

  4. Agree to and sign the ROL document.

  5. Fill out the SRI Mental and Physical Health Status Assessment Survey (MPHSAS).

  6. Complete the PGTIAP application form, and obtain a copy of your medical records from your primary physician relevant to your terminal illness.

  7. Turn in the PGTIAP application, TC, ROL, MPHSAS, and your medical records to Shaman's Reach Inc. (SRI) located at 11131 Highway 49 North, Brookland AR, 72417, Monday through Friday between 9 am and 4 pm. Allow for five business days for senior SRI representatives to review and confirm your case and get in contact with you and your physician.  

  8. If qualified, you will be given one month's worth of a specially formulated high strength full-spectrum tincture and a topical product meant to help with localized pain. You will need to come back each month and fill out another MPHSAS to receive your next supply of products. 

Required Paperwork

PGTIAP Application Form

Terms and Conditions Document

Release of Liability Document

MPHSAS Document

We use the information gathered from this study to assess the effects of cannabinoid therapy on your illness as well as your mental and physical wellbeing. All Personal Identifiable Information (PII) from this study will be used only by Shaman's Reach Inc. and will not be shared with anyone outside of Shaman's Reach Inc. and your primary physician without your written permission.  

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