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Medical Marijuana Forms

 

ALERT:  The application fee has been reduced to $15 effective February 1, 2014. 

 

Downloadable Forms: New user-friendly forms are available through the Medical Marijuana Registry in writeable PDF format. As the Registry updates forms, they will be posted on the website. Please check back frequently for updates.

 

Medical Marijuana Registry Forms

Form #

Form Name

PDF

MMR1001
 

Application for Registration Card (Adults, 18 and older)

  1001.pdf pdf file
MR1002
 

Medical Marijuana Registry Card Application for Patients Under 18 Years of Age

  1002.pdf pdf file

MR1003

Change of Patient Records

1003.pdf pdf file

MMR1004

Report of Lost, Stolen or Damaged Registry Card

1004.pdf pdf file

MMR1005

Request for Patient Information

1005.pdf pdf file

MMR1006

Voluntary Caregiver Registration

1006.pdf pdf file

MMR1007

Request to Surrender Registry Card

1007.pdf pdf file

MMR1008

Removal from Voluntary Caregiver Registry

1008.pdf pdf file

MR1010

Request for Fee Waiver/Tax-Exempt Status

1010.pdf pdf file

MMR1011

Change of Homebound Status

1011.pdf pdf file

MMR1012 NEW: Caregiver Acknowledgment   1012_pdf pdf file
MMR1013 NEW: Provider Information Update   1013_pdf pdf file
MMR1014 NEW: Signature Revocation   1014_pdf pdf file  

  

Tips for Successful Submissions
The Medical Marijuana Registry frequently rejects forms due to easily preventable mistakes. Use the Forms Checklist to help you avoid delays in application or forms approval.
 

Documentation Requirements

MMR Policy #2012-8 pdf file  provides guidelines for establishing identity and residency for applicants, caregivers, parents/guardians, or individuals with medical power of attorney for a patient.