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.
GoDaddy.com SSL certificates support both industry-standard 128-bit (used by banks to safeguard sensitive data) and high-grade 256-bit SSL encryption to protect online transactions.
This SSL Certificate protects information flowing to and from our site and your computer from cyber thieves intent on stealing personal data. Names, addresses, passwords, account and credit card numbers – all are safe with our SSL.
This SSL certificate also guarantees that the Certificate holder Greenleaf Care, is who it claims to be and has a legal right to use the domain from which it operates.
Visit us socially!
Become a Facebook fan, add us to your Google Plus circle or Tweet about us. We would love to hear from you.