To make an appointment you must be at least 18 years of age.

Appointment Request Form

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What to Bring to your Appointment

NEW PATIENTS:

1. Medical Records

The records do not have to be extensive, but should satisfactorily document the medical condition for which you wish to use medical marijuana. The records should clearly state a diagnosis, detail any tests performed, and indicate treatment prescribed. Records from your patient portal are acceptable. Please see complete details in in the Medical Records section.

Please do not mail them to our office. You can fax the records to (815) 366-7913. It is preferable to bring the records with you. PLEASE DO NOT STAPLE RECORDS TOGETHER AS THEY WILL BE SCANNED AND RETURNED TO YOU. If you have to obtain your records, you may arrange an appointment, provided you agree to submit records within 2 weeks. 

2. Print out, read and complete the following two (2) Patient Forms and bring them to the appointment:

Also please review the form entitled Medical Marijuana Benefits and Risks (PDF) before your appointment.

Completing the forms in advance will save you about 30 minutes during the appointment.

3. Picture Identification

  • Massachusetts driver’s license;
  • Massachusetts ID card (with a photograph of yourself);
  • U.S. passport and another document that proves your Massachusetts residency; or
  • U.S. military ID and another document that proves your Massachusetts residency

4. Proof of Residency

  • Home mortgage or lease; or loan contracts
  • A utility bill (gas, electric, wired telephone, wired cable, or heating oil delivery bill), no more than 60 days old, that contains the applicant’s name and residential address
  • Current Massachusetts motor vehicle registration card
  • A property tax or excise tax bill for the current year and contains the applicant’s name and residential address
  • First-class mail from any federal or state agency that displays residential address (dated within 60 days of application)
  • Voter registration signed and certified by city/town clerk

4. The last four digits of your social security number.

Please note our fees and cancellation policy.  Our fees are not covered by insurance.  Payment is due at the time of an appointment.  (See services and fees)

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RENEWALS:

1. If your condition has been stable since your last visit, and your certification expired less than six months ago, no new medical records are necessary. If your medication or treatment has changed, please bring a copy of  the progress note from your last visit with your PCP or specialist.

2. The last four digits of your social security number.

3. Picture Identification

  • Massachusetts driver’s license;
  • Massachusetts ID card (with a photograph of yourself);
  • U.S. passport and another document that proves your Massachusetts residency; or
  • U.S. military ID and another document that proves your Massachusetts residency

4. Proof of Residency

  • Home mortgage or lease; or loan contracts
  • A utility bill (gas, electric, wired telephone, wired cable, or heating oil delivery bill), no more than 60 days old, that contains the applicant’s name and residential address
  • Current Massachusetts motor vehicle registration card
  • A property tax or excise tax bill for the current year and contains the applicant’s name and residential address
  • First-class mail from any federal or state agency that displays residential address (dated within 60 days of application)
  • Voter registration signed and certified by city/town clerk

4. Please review our form entitled Medical Marijuana Benefits and Risks (PDF) before your appointment.

Please note our fees and cancellation policy.  Our fees are not covered by insurance.  Payment is due at the time of an appointment.  (See services)