certification exam pre appointment forms

Once scheduled for your certification exam you will receive an email with a personalized link and password to complete the required intake forms. We greatly appreciate you submitting these forms at least 48 hours in advance of your appointment. This allows us time to review your information and ensure that you have an individualized and valuable visit with our doctor. These forms MUST be completed in order to receive your medical cannabis certification.  

Please only use the links below IF YOU DID NOT RECEIVE this access via email. If you scheduled online you will receive the forms after our staff confirms your appointment.

New Patient Initial Evaluation
Transfer Patient Evaluation

You will be given an option to upload your medical records with your intake forms. If you don't have a digital version that's okay - just bring a copy with you to your appointment. 

Follow Up Evaluation 
This is for established patients ONLY. New patients DO NOT need to fill out this form. 

State registry application

State Registry Application

After your initial appointment with the doctor, you will need to submit a registry card application to the State. You can print and mail the application, along with the required documentation, photo, and fee, or you can complete it online. If your Florida Driver's License or State ID photo does not import into the registry you will also need to upload a passport photo. You will gain access to the online registry at the time of your initial appointment.

Online Application
Online Registry 

Paper Applications
Patient & Caregiver Applications

Application Tips
How to Complete Your Registry Application 

Medical Records Upload

Securely send your medical records. 

Medical Records Patient Submission