Helping people make sense of medicinal cannabis in Canada
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Patient Intake Form

Have you previously had a prescription for medical marijuana, if the answer is yes, then your appointment is considered a renewal.
Include all current or previous prescription including dosage. If you do not take prescribed medications please write: cannabis only.
If the answer is none, leave this box blank or put N/A
If you do not currently have a prescription for medical marijuana please enter 0
Please request a number of grams between 1 and 100 for daily consumption. Please note for anything higher than 75 grams per day a previous medical marijuana prescription is required.
Please upload a copy of your valid goverment issued photo ID (drivers licence, passport, health card, province id card, military card)
Please upload any medical documents you have access to; a photo of a prescription bottle with your name or receipts from a chiropractor or RMT will suffice.