The Client or Person Responsible for the Client must complete this section (please read each statement and sign below)
All Clients must fill out this section. All fields are required unless otherwise indicated (Must match the medical document)
Client with a caregiver must fill out this section
am responsible for
If your health care practitioner has consented to receive your product please contact ABcann to obtain the necessary documentation.
Management must sign declaration
Address of establishment is the same as Client address *Shelter, Hostel, Hospital, Care Facility or similar establishment
attest that I am the manager of the establishment named above. I attest that this establishment is located in Canada and provides food, lodging or other social services to the applicant,