New Patient Registration Form * Name First Last * Delivery Address Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP Code * Phone Number * Date of Birth * Email Email Confirm Email * Recommendation Information Max file size is 67 MB. Please upload a photo copy of Reccomendation. If you do not have a scanner, you can upload a photo taken from your smartphone. * California Driver's License or California Identification Max file size is 67 MB. Please upload a photo copy of valid California Driver's License or California Identification. If you do not have a scanner, you can upload a photo taken from your smartphone. Notes or Comments Reach out to us, one of our staff will get back to you! Check Out Our Menu! All the best Indicas, Sativas, Hybrids, Pre-Rolls, Edibles, Drinks, Concentrates, Tinctures, Waxes and Topicals, delivered to your door by our friendly professional staff! Click Here
