Patient Inquiries Form

If you are in need of further support, please fill out the form below.

    Preferred Contact (Select all that apply)

    Preferred Day/Time for contact

    Closest Clinic Location

    I am (select all that apply)

    Current medical cannabis patientInterested in becoming a patientPrevious PatientInterested in participating in researchCaregiverOther

    Reason (select all that apply)

    Please let us know of any other details that might help us to assist you


    Providing high quality of care is important to us