Thank You for your interest in Medical Cannabis!
This form is FEE to complete and is HIPPA compliant
- Evaluaiton cost = $300. A $100 deposit will be required prior to schedulinhg.
- Submit this application and our office will call you to schedule
Notice of Privacy Practice (Receive a copy in our office on your appt day!)
I have read and fully understand the policies of this office regarding:
Medical Marijuana Patient Declaration
You are all done!
Please push Submit to send us your application.
A $100 deposit is required to schedule. After you push "Submit" you will be re-routed to our payment section.
Our team will contact you AFTER you've paid the $100 deposit. This will be applied to your total appointment or kept if the appointment is no-showed.