Therapeutic Cannabis Applications and Forms
Find application forms and other documents and guidance for Qualifying Patients, Designated Caregivers, and Guardians in the Therapeutic Cannabis Program.
Applications
- Patient Application
- Written Certification
To be completed by the Certifying Medical Provider - Caregiver Application
- Minor Patient Application
Combined application for a Minor Patient and their Caregiver (caregiver must be the patient’s parent or legal guardian) - Guardianship Patient Application
Combined application for an Adult Patient and their Caregiver (caregiver must be the patient’s legal guardian)
Information Sheets
- Patient Information Sheet
- Caregiver Information Sheet
- Medical Provider Information Sheet
- Minor Patient Information Sheet
- Notice Explaining Federal Law
- Protections and Prohibitions for Patients
- Protections and Prohibitions for Caregivers
- Therapeutic Cannabis Laws & Tips for Safe and Responsible Use
- Child Safety Tips for Parents and Grandparents & Preventing Youth Use of Recreational Marijuana
Other Forms
- Change of Information / Lost Card Form
Use this form to change your name, or your address, or to report a lost card and request a replacement - Caregiver Designation / Removal Form
Use this form to add or remove a caregiver or patient after you have been issued a Registry ID Card - Written Certification Extension
For Certifying Medical Providers to extend a previously issued Written Certification of less than three years - Written Certification Withdrawal
For Certifying Medical Providers to withdraw a previously issued Written Certification - Card Deactivation Request Form
Use this form to request Registry ID Card deactivation - Caregiver’s Attestation of No Felony Conviction
For Caregiver applicants using older applications (pre-7/22 versions)