Medical Marijuana Forms

ALERT: 

• New forms available below. As a result of a policy and procedures review, the Registry has released new forms with the following changes.  Please see forms for complete details.
  • Proof of residency is now required only on the application form.
  • Proof of identity requirements have been clarified.
  • Documentation requirements for proof of residency have changed.
  • Forms now feature a two-letter code in the upper right corner for easier identification.
     
• The application fee was reduced to $35 effective January 1, 2012.  Please be sure that the patient's name and the last four digits of the social security number are on the check or money order made out to CDPHE.  Please DO NOT send money with any form other than the application. All money received by the Registry is processed and is nonrefundable.

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
MMR1002	Medical Marijuana Registry Card Application for Patients Under 18 Years of Age	1002.pdf
MMR1003	Change of Patient Records	1003.pdf
MMR1004	Report of Lost, Stolen or Damaged Registry Card	1004.pdf
MMR1005	Request for Patient Information	1005.pdf
MMR1006	Voluntary Caregiver Registration	1006.pdf
MMR1007	Request to Surrender Registry Card	1007.pdf
MMR1008	Removal from Voluntary Caregiver Registry	1008.pdf
MMR1009	Caregiver’s Patient Limit Waiver	1009.pdf
MMR1010	Request for Fee Waiver/Tax-Exempt Status	1010.pdf
MMR1011	Change of Homebound Status	1011.pdf

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

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