New Patients

Certification Appointment Request

If you are seeking a Medical Marijuana Certification Card for the first time and would like to schedule an appointment, please submit ALL of the form information below.

Please note this is an appointment request and you will be contacted by an MCC professional to schedule your exact appointment time.
When your appointment is confirmed, we will send you a payment link to complete and your Telemedicine schedule will be finalized.

If this is a re-certification of an existing Medical Marijuana Card, please click here.

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Phone(Required)

Email(Required)

What Days Are Convenient For You(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Preferred Appointment Time(Required)

Please state your Medical Condition for Certification(Required)

After receiving your appointment request one of our professionals will reach out via phone or email to confirm your appointment time and to arrange payment.