Rhode Island- Contact and Appointment Form

B & B Medical Marijuana Evaluation Center of Rhode Island

Contact & Appointment form
What can we help you with?

I need an initial medical marijuana card, or I need to renew the card I already have I want to see information about fees, process, etc. I have a general question
Name *

First Name Last Name
Email *
Please submit an email so that we can respond to your questions promptly.
Phone Number *
Please enter a valid phone number.

You choose the amount of time this form takes

Option 1- Take extra time to submit forms Option 2- skip to submission page & have us reach out
Would you like to fill out forms and submit documents you will need later, or submit this information now and have us reach out to you? *

Fill out forms & submit documents Submit this & wait for us to reach out

Skip the line to get your initial medical card or renew your existing one

Complete the following steps online to get faster service
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State

Zip Code
Date of Birth

Month Day Year
Email
example@example.com
Phone Number
Please enter a valid phone number.
What qualifying condition are you diagnosed with?
Select one
Do you also want to fill out a release form?--You may need to fill out a release form before your appointment, so it is always best to say yes--The release will be emailed to you *

Yes No
You will need to submit ID and other Documents for proof of residency or a discount. *

I want to submit documents now I will submit documents later

Documents we need from new patients to our office

You may also upload medical records here if you have them on hand
Our office will require some documents prior to your appointment to remain compliant with state law.

What you need to submit:

Proof of Residency

Proof of Discounted Status
Submit one of the following documents to prove residency:

Driver’s license or state ID Car insurance or registration Any communication from a RI State agency
Submit one of the following for Proof of Discount.

SSI/SSDI Award Letter Benefit Verification Letter (if you were disabled, but you are now over 65) VA status/disability benefits Medicaid Anchor Card
Submit Proof and/or Medical Records here

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Information Guide
After reading the below information, would you like to start the process? *

Yes, I want to start the process by filling out your contact form I want your office to reach out to me before filling out anything No, I am just checking out your information

Fees
NEW & RENEWING PATIENTS: $150

DISCOUNTED PRICE: $140

6-Month Follow-up: $50

Submit your form below

We will reach out to you as quickly as possible
Comments/Concerns
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B & B Medical Marijuana Evaluation Center of Rhode Island