Thank you for completing this intake form. Below you will have the option to "PRINT" which allows you to print a copy of this form for your records.
When you click "SUBMIT" below, this will be transmitted to CANNABIS CARE through a HIPPA secure portal for our review. We will be able to start creating your medical record.
1. On www.mybccannabis.com you must still complete the MEDICAL RECORD RELEASE FORM.
We recommend that you call your PCP/specialist and ask if they can fax your last office visits to us at 724-257-2158 ASAP so that we can compile your chart. Any delay in receiving your records will delay your visit with us.
2. Make sure you visit https://padohmmp.custhelp.com/app/login to register with the Pennsylvania Department of Health and receive your Marijuana Patient ID number. It takes less than 2 minutes to do! You will need this number when you come for your appointment with us!
3. View our FEE SCHEDULE on mybccannabis.com