Pre-qualify For Medical Marijuana On-line Form
All patient information is completely confidential. We are HIPAA compliant and protect patient privacy at all times.
WHAT TO BRING TO YOUR VISIT
A valid driver's license, passport, or other valid form of identification. A list of medications you are taking, including dosages and directions. Any reports or diagnosis from your primary care physician.
Pre-filled new patient information form questionnaire to make your visit faster.
Will I Pre-qualify?, For Immediate answers, call 1-888-774-7076 of fill out our form below.
When you submit this form, your information will be sent to a medical professional in your area. We will review your information and get back to you with your pre-qualification results.
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