PreQual 2.0

1
I am applying for* This field is required.
Certification ($189)
Recertification ($99)
2
Which state are you applying in?* This field is required.
NJ - New Jersey
NY - New York
PA - Pennsylvania
Somewhere Else
3
Which qualifying condition(s) do you live with?* This field is required.Select all that apply. Please note these are the qualifying conditions as outlined by the New Jersey Department of Health.
Amyotrophic lateral sclerosis
Anxiety
Cancer
Chronic Pain
Crohn’s Disease
Dysmenorrhea
Epilepsy or other Seizure Disorder
Glaucoma
HIV+/AIDS
Inflammatory Bowel Disease
Intractable Skeletal Spasticity
Migraine
Multiple sclerosis
Muscular dystrophy
Opioid Use Disorder
Post Traumatic Stress Disorder
Terminal Illness (w/ 12mo Expectancy)
Tourette Syndrome
4
Which qualifying condition(s) do you live with?* This field is required.Select all that apply. Please note these are the qualifying conditions as outlined by the Office of Cannabis Management NY.
Amyotrophic lateral sclerosis
Anxiety
Cancer
Chronic Pain
Crohn’s Disease
Dysmenorrhea
Epilepsy or other Seizure Disorder
Glaucoma
HIV+/AIDS
Inflammatory Bowel Disease
Intractable Skeletal Spasticity
Migraine
Multiple sclerosis
Muscular dystrophy
Opioid Use Disorder
Post Traumatic Stress Disorder
Terminal Illness (w/ 12mo Expectancy)
Tourette Syndrome
5
Which qualifying condition(s) do you live with?* This field is required.Select all that apply. Please note these are the qualifying conditions as outlined by the Pennsylvania Department of Health.
Anxiety
ALS/Lou Gehrig's Disease
Autism
Brain/Spinal Nervous Tissue Damage
Cancer
Chronic/Intractable Pain
Crohn’s Disease
Epilepsy/Tourette’s
Glaucoma
HIV/AIDS
Huntington’s Disease
IBD/Inflammatory Bowel Disease
Intractable Seizures
Multiple Sclerosis
Neurodegenerative Diseases
Neuropathies
Opioid Use Disorder
Parkinson’s Disease
PTSD/Post-Traumatic Stress Disorder
Sickle Cell Anemia
Spastic Movement Disorders
Terminal Illness
6
Do you have medical records to support this diagnosis?JSB Certifications only considers Official Medical Records to be one or more of the following: Primary Care Physician (PCP) Visit Summary, PCP-Issued Letter of Diagnosis, Behavioral Health Evaluation/Recommendation.
Yes, I have records.
No, I do not have records.
7
Would you like support in obtaining medical records to verify your condition?We'll send you an email with references to some of our preferred partners.
Yes! Please send some resources.
No, I'm good.
8
Great. Where should we send the information?* This field is required.Please enter your email address.
Your email address.
Confirm your email address.
9
Unfortunately, we're only servicing patients in the Pennsylvania, New Jersey, and New York markets at this time.

However, we have a robust network of collaborators nationwide. Please drop us a line at hello@jsbcertifications.com and we'll see what we can do to support your needs.
10
Got it. Before you go:

Some info on medical records.

Medical Records are required by the Department of Health as proof of illness / qualification for all certified Medical Marijuana Patients in the program.

Just so you know, when you come back. JSB Certifications considers any of the following to be an official medical record:

Primary Care Physician (PCP) Visit Summary*

PCP-Issued Letter of Diagnosis

Active Perscriptions (Bottles + Labels Fulfilled within 90 Days)

Behavioral Health Evaluation/Recommendation**

* Visit Summaries must include clear and definitive mention of a pre-existing or new diagnosis. ** Behavioral Health Evaluations/Recommendations are valid only on psychiatric disorders (Anxiety/PTSD) and considered to be formal letters of recommendation issued on the official letterhead of State Licensed and Certified clinicians with a Masters or Ph.D. in psychology or another area of behavioral health studies. JSB Certifications will not accept letters of recommendation from life coaches, school counselors, or other unlicensed advisors.
11
Referral Source
12
Awesome. You've been pre-qualified!

Based on the fact that you're seeking {iAm} for the treatment of {whichQualifying} and that you have official medical records to support this ailment, you can now move on to submit our intake form.

Use the button below to proceed.
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