Print Registration

New Membership Registration

Forms can be found by clicking the links below.

In order to receive our services, applicants must:

  1. Print and complete the following forms
    1. Application for Registration (Form A)(Instruction Sheet Included)
    2. Medical Document (Original copy required for membership) – To be completed by your health care practitioner

Optional Forms

    1. Letter to Doctor – You can give this to your doctor with your form.
    2. Health Canada Release Form for Medical Practitioners – If needed, this is a form from Health Canada which reduces your doctor’s liability in regards to your use of medicinal marijuana.
    3. Medical Information Release Form – If needed, this form empowers your health care provider to send us your confirmation of diagnosis.

 

Mail Order Applicants (Additional Information & Requirements)

  1. Provide a legible copy of government issued photo ID
  2. Send a copy of your forms and ID by Fax or Email to 855-373-3420 or registration@medpotnow.com
  3. Please allow 1-2 weeks for processing once we receive your application.