Use the form below to register or renew your medical card.

Whether you’re a new or existing patient, anyone is welcome to register with us online. Upon completion, you will be contacted for your appointment. Please note: this data is encrypted, not sold or shared, and held privately and confidentially by your doctors offices at Compassionate Certification Centers. If you prefer to register over the phone, please contact us today at 888-316-9085.
First Name *
Last Name *
Email Address *
Cell Phone Number *
Secondary Number
Landline Number
May we leave a message on your voicemail? *
Date of Birth *
Gender *
Designation *
Qualifying Condition *
Desired Office Location
Reason for Contact *
How Can We Help? *
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