Did you know?
Pre-Qualify
Prequalify with these 6 questions!
1) Are you a California resident and possess a valid ID or proof of residency?
2) Do you have a medical condition that could benefit from the use of cannabis? (Arthritis, Chronic Pain, Gastrointestinal Disorders, Insomnia, Glaucoma, Movement Disorder, Depression, Anxiety, Cancer, Nausea, Bulimia, Anorexia, etc.)
3) Have you been previously diagnosed for your condition?
4) Do you have any medical paperwork to support your diagnosis? (X-rays, MRIs, prescriptions, physician letters, medications or any other documentation showing that you have been to a doctor and have been diagnosed with your condition.)
5) Can you provide the contact information for any of the physicians who have treated you for your diagnosis that you are being evaluated for?
6) Are you currently on probation or parole?
If you answered YES on questions 1 through 5, and NO on 6 then you are a candidate for a “Medical Cannabis Recommendation”.
If you answered NO to questions 3, 4, or 5 then you may still qualify for a three month “limited” recommendation.
Please call our office to schedule an appointment.
When coming to your appointment please bring with you a valid California ID, any medical paperwork that supports your symptom(s) and your Physicians information.
Please call to make an appointment at PH 949.600.8888
or print complete, and fax this form to FX 949.600.8889
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