Download the appropriate form(s) below for registration. If you are unable to download the forms you may need to download Adobe Acrobat Reader software. This software is free. You may also complete your application electronically by going to the Online Services section of our website. The forms below are only needed if they cannot be sumitted electronically through the Online Services section of our website.
- Registration Packet (Includes forms for the patient, caregiver, and health care professional)
- Mental Health Care Provider Form (Required for patients applying with PTSD)
- Cardholder Change/Request Form (This form is for patients to change dispensaries, update their information, or request a new ID card.)
- Dispensary Selection Information (This document contains information provided by the dispensaries to assist applicants designating a dispensary)
- Patient Notice of Appeal Form