Medical Marijuana Card Pre-Qualification

Complete the form below to see if you’re eligible for a medical marijuana card in your state.

Only proceed if: you are able to show your state residency by providing a copy of one of the following: driver’s license, state issued identification card, registry identification card, or photograph page in your current US passport.

Tell us about yourself

First Name *
Last Name *
Email Address *
Phone Number
Date of Birth
State of Residency *

Choose your medical condition(s)

Alzheimer’s DiseaseALSCancerCrohn’s DiseaseGlaucomaHepatitis CHIV/AIDSPTSDSevere and Chronic PainSevere NauseaSevere Muscle SpasmsSeizuresOther

Tell us a little more about the medical condition(s) details you selected above

Yes I certify that I have the proper residency requirements and am not currently on parole or probation. *
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