Patient Self Referral Forms

Patient Self Referral Forms

It’s best when patients are referred into our clinic, as their primary care physician or healthcare provider is more likely to be familiar with their complete medical history and aware of any issues or concerns which may impact or in some cases preclude cannabinoid therapy.

If possible, have your Referral Forms completed by a healthcare provider.

If you believe medical cannabis may be right for you but are unable to secure a referral, it is possible for a doctor in our clinic to determine if you may be a candidate for medical cannabis without a formal referral.

Please complete the Patient Self Referral Form below

Patient Self-Referral Form