Cannabis Reporting Form

Privacy Notice Statement

The personal information you provide is protected in accordance with the Privacy Act and is collected under the authority of Section 4 of the Department of Health Act. Your contact information is being collected to enable Health Canada to follow up with you regarding your report and may be used to initiate an investigation, authorized under Part 7 of the Cannabis Act. The information that you provide may be provided to the party subject to this report or to provincial, territorial or federal regulatory agencies in order to address the matter you have raised. However, the personal information you provide about yourself would not be provided to the party subject to the report without your consent. To safeguard privacy, please ensure that you limit the amount of personal information you provide in the text of your report. For more information please refer to the personal information bank Public Communications PSU 914 at You have the right to access your personal information and correct any incorrect information. You have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly. For details regarding the handling of your personal information, please contact Health Canada’s Privacy Management Division at

Information about who is reporting

Please include details about yourself in this section

Who are you

  • General public
  • Consumer
  • On behalf of consumer
  • Industry
  • Organization
  • Province or Territory
  • Municipality
  • Media
  • Retailer
  • RCMP
  • Health care practitioner
  • Pharmacist
  • Other


  • Canada
  • Other

Health Canada may contact you to obtain additional details or clarification about the information you are submitting.

Reason for report

Note to screen readers: The following selection "Report related to" will allow you to pick the topic of your report. If you select "Cannabis product/accessory", it will add 2 sections to this form called “Cannabis product or accessory”. It allows you to enter up to 5 products or accessories and a section called “Where was the cannabis product or accessory purchased”. If you unselect this option, it will remove those sections and any information you may have entered into them.

Report related to

  • Cannabis product or accessory
  • Service related to cannabis
  • Site related to cannabis
  • Promotion/advertising/marketing related to cannabis
  • Other

Is this report associated with a side effect or injury?

  • Yes
  • No
  • Unknown
Please provide a sufficient description of the cannabis issue that you are experiencing.

Information regarding the Party Subject to this report

If this report is related to a specific cannabis product or accessory, this information can be found on the label of the cannabis product or accessory.

If this report is associated to a site related to cannabis, a service related to cannabis, a promotion/advertising/marketing related to cannabis, or other, please provide as much information as possible as it relates to the subject of the report.


  • Canada
  • Other

Was this information reported to the party subject to the report?

  • Yes
  • No

Documents and pictures

Please upload any additional information that you wish to include in the Cannabis Reporting Form.

The following file formats are supported: DOC, DOCX, PDF, RTF, XLS, XLSX, BMP, GIF, JPEG, PNG, TIFF.

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