ALERT:  Effective January 1, 2012, the application fee changes to $35.

 

No Refund Policy: The Registry does not issue refunds. Please be sure to submit the accurate application fee based on the date of submission.

  • Applications submitted by or before December 31, 2011: The fee is $90 for applications received by or before December 31, 2011. Applications received with less than $90 will be rejected.  If you are submitting a new application by or before December 31, 2011 please click here for the appropriate application form.
  • Applications submitted January 1, 2012 or later: The fee is $35 for applications received at the Registry on January 1, 2012 or later.  The Registry will not issue a refund to patients who send the application in with more than $35. To submit a new application on January 1, 2012 or later, download form MMR1001 from the list below.

Downloadable Forms: New user-friendly forms are available through the Medical Marijuana Registry in both printable PDF format and writeable Microsoft Word 2007 format.  As the Registry updates forms, they will be posted on the website.  Please check back frequently for updates.

Medical Marijuana Registry Forms

Form # Form Name PDF Word*
MMR1001 Application for Registration Card (Adults, 18 and older)(effective January 1, 2012) 1001.pdf 1001.dot
MMR1002 Medical Marijuana Registry Card Application for Patients Under 18 Years of Age (effective January 1, 2012) 1002.pdf 1002.dot
MMR1003 Change of Patient Records 1003.pdf 1003.dot
MMR1004 Report of Lost, Stolen or Damaged Registry Card 1004.pdf 1004.dot
MMR1005 Request for Patient Information 1005.pdf 1005.dot
MMR1006 Voluntary Caregiver Registration 1006.pdf 1006.dot
MMR1007 Request to Surrender Registry Card 1007.pdf 1007.dot
MMR1008 Removal from Voluntary Caregiver Registry 1008.pdf 1008.dot
MMR1009 Caregiver’s Patient Limit Waiver 1009.pdf 1009.dot
MMR1010 Request for Fee Waiver/Tax-Exempt Status (effective January 1, 2012) 1010.pdf 1010.dot
MMR1011 Change of Homebound Status 1011.pdf 1011.dot

Tips for Successful Submissions The Medical Marijuana Registry frequently returns application packets and forms due to easily preventable mistakes. Click here for a checklist to help you avoid delays in application or forms approval.   Using Microsoft Word 2007 writeable forms All files in the WORD column above are Microsoft Word 2007 template files.  These forms download directly onto your computer. The forms are content protected to allow access only to areas that are writeable.  Please use the TAB button on your keyboard to move from section to section.  Data entered into the forms does not save on the Registry’s website. If you need to return to a form, we recommend saving it on your computer.   *Obtain the latest Word Viewer if you do not have Microsoft Word installed on your computer.

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