By signing below, I consent to receive the above marijuana product that has not been tested as required by the Medical Marihuana Facilities Licensing Act, MCL 333.27101 et seq., and the Administrative Rules, R 420.301 et seq. I acknowledge that the use of untested marijuana products may lead to adverse reactions or worsen existing health conditions and such products are used at a patient's own risk. I understand that a patient or caregiver may take marijuana products to be tested at a state-licensed safety compliance facility and a list of those facilities can be
found by visiting www.michigan.gov/mra/ or by calling 517-284-8599.