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 *
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    Address 1 *
    Address 2
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    Country *
    Date of Birth *
    Designation *
    Reason for Contact *
    Qualifying Condition
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    Language *
    Desired Office Location
    How Can We Help? *
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