Step 2 – Medical Marijuana Card Application

Please complete the form below
Personal information
Medical History

Top medical problem/condition for which you seek an evaluation?

Are you taking any other medications?

Do you have allergies from medications?

Have you experienced or been diagnosed with any of the following?

Do you have a primary care provider?

Do you have medical records from a primary doctor describing your diagnosis?

Protected Payment

When obtaining a medical card you will not be charged until after you complete your evaluation with one of our preferred doctors. Instead, a hold for the amount will be placed on your card immediately. If you are not approved the hold will drop off of your card in 3-5 days.

Medical Marijuana Recommendation + Card
Quantity: 1
Valid for 12 months
Price: $50

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Medical Cards are in high demand.
It is estimated that 65,000 people are on waiting lists

1%

Marijuanabreak is connecting to dozens of doctors in your area
to check pricing and availability.

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Step 2 – Medical Marijuana Card Application
May 22, 2017