Patient Registration

First Name

Last Name *

Phone Number

E-mail *
Date Of Birth
License Number
License Files

Select Image

Upload Your Drivers License

Select File(s)
License Expiration Date
A Photo of State ID and Physician Certification will be required Prior to first delivery.
Your Address

Address Line 1 *

City *

State *

Zip Code *
Password *
Confirm Password *
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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