Application Forms & Instructions

Please use the applications below if you are applying for or renewing your registration

Applications

The ORIGINAL and RENEWAL APPLICATIONS are now COMBINED

NOTE:  NEW FORMS EFFECTIVE OCTOBER 1, 2017

• MMMP Application Packet (Applicants 18 and Over)

• MMMP Minor Application Packet (Applicant under 18 years of age)

Change Forms

Please use the Change Forms below to make changes to your registration:

NOTE:  NEW FORMS EFFECTIVE OCTOBER 1, 2017

• Name or Address Change Form

• Add or Change Caregiver Form

• Remove Patient Form

• Remove Caregiver Form

• Request Replacement Card(s) Form

Release Forms

Please use the Release for Disclosure of Information form below if you require specific information to be released concerning your participation in the Medical Marihuana Registry Program:

• Release for Disclosure of Information Form

• Medical Records Release Authorization

Note: You will need Adobe Reader in order to download the application forms, which can be downloaded at http://get.adobe.com/reader/.