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7
E-mail* This field is required.
8
Have you been experiencing Chronic Pain for 12 months or more?* This field is required.Must answer Yes to be qualified for a Medical Marijuana card today
YESNO
9
What part of the body are you experiencing your chronic pain?* This field is required.Please name the part of the body
10
How long have you been experiencing this pain?* This field is required.Must be at least 12 month or greater to qualify
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Using the scale from 1-10 please rate what level your pain is.* This field is required.
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Pain Scale
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Pain Scale
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Do you currently receive EBT/ Foodstamps? * This field is required.Must show proof
YESNO
13
Please take a Clear Full Photo of your Arizona Identification Card/ Drivers License or US Passport* This field is required.
14
Please take a full headshot photo of yourself with no hat, or sunglasses on a plain wall background for your MMJ Card Photo* This field is required.
15
Signature* This field is required.I understand that once the doctor signs my certification, there are no refunds.
16
Payment
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ORDER SUMMARY
Total costUSD
Premium MMJ Certification: $145
Includes physical wallet card shipped to you. (Must send PDF from state for us to complete) No refunds once doctor has certified you
$145.00Edit
Back
Premium MMJ Renewal
Includes physical wallet card shipped to you. (Must send PDF from state for us to complete) No refunds once doctor has certified you
$145.00Edit
Back
Arizona Medical Marijuana Certification
Only $115 Charged now (no refunds once doctor has certified you) the State fee of $150 will be charged after talking with doctor. Those two fees together equal $265 total for the marijuana card.
$115.00Edit
Back
MMJ Renewal
Only $115 Charged now (no refunds once doctor has certified you) the State fee of $150 will be charged by state after talking with doctor. Those two fees together equal $265 total for the marijuana card.
$115.00Edit
Back
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