MICHIGAN MEDICAL MARIJUANA CARD
Provide your medical history and book a virtual appointment with a licensed marijuana doctor.
Name
*
First Name
Last Name
State
*
Please Select
Michigan
Please select your state:
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Are you taking any medications?
*
Please Select
Yes
No
What medication are you currently taking?
Have you ever experienced hallucinations before?
*
Please Select
Yes
No
Have you ever been diagnosed with schizophrenia?
*
Please Select
Yes
No
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What is your medical history like?
*
Please Select
Chronic Pain
Post - Traumatic Stress Disorder (PTSD)
ALS - Amyotrophic lateral Sclerosis
Cachexia
Multiple Sclerosis
Parkinson's Disease Epilepsy
Spinal Cord Injury with Spasticity
Neuropathy
Crohn's Disease
Alzheimer's Disease
Canser
HIV or AIDS Positive
Inflammatory Bowel Disease
Huntington's Disease
Hydrocephalus with intractable Headache
Wasting Syndrome
Muscular Dystrophy
Neuropathic Facial Pain
Osteogenesis Imperfecta
Opioid use or substance use disorder.
Other Condition
Any condition for which an opioid could be prescribed (provided that the precise underlying condition is expressly stated on the patient’s certification).
Substance Use Disorder
How long have you been dealing with this pain, in month/year?
*
What condition are you dealing with ie chronic pain seizures?
What is the condition due to ie pain in lower back due to motor vehicle accident, herniated discs in lower back due to job requiring heavy lifting?
Upload a valid state ID?
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Medical Marijuana Doctor Consultation
15 or 25 minute one-on-one consultation with a license medical marijuana practitioner. Strategic and carefully crafted action plan for your personal medical cannabis use. PDF summary of your appointment with the doctor.
$
59.00
Medical Marijuana Card Renewal
15 or 25 minute one-on-one consultation with a license medical marijuana practitioner. Strategic and carefully crafted action plan for your personal medical cannabis use. PDF summary of your appointment with the doctor.
$
169.00
Medical Marijuana Card Evaluation
The $199 fee includes your consultation fee, physician copay, and the medical evaluation for your recommendation. PAYMENT IS FULLY REFUNDABLE IF YOU ARE NOT GET APPROVED
$
199.00
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