Patient Registration

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Last Name *

E-mail *

Phone Number *
Date Of Birth
License Number
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A Photo of State ID and Physician Certification will be required Prior to first delivery.
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*DISCLAIMER*
This information is not intended to be utilized as medical advice or treatment without your personal physician’s advice. This information is not intended to take the place of your personal medical physician. Please consult with your personal physician for medical advice, treatment, questions, or concerns. We are a cannabis practitioner business run by a licensed LPN.

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Patient Registration

A Photo of State ID and Physician Certification will be required Prior to first delivery.

Email

Phone

Address

Email

Phone

Address