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PATIENT INTAKE FORM

Thank you for registering with CannMedLive.  We want to make the process of obtaining your prescription for medical cannabis as easy as possible for you and be within the Health Canada guidelines.  Whether  you have a medical cannabis prescription or not, CannMedLive would like to obtain an up to date Medical Document for you by filling out our Patient In-Take Form.  You do not require a referral from your family physician.

Please fill out our Patient Intake Form by clicking on the link below where you can fill out and submit the form online. When you have completed the form, click DONE on the top right hand corner of the form.  You will be given a choice to email yourself a copy of the completed form or to download it.

 

If you wish to print out the form and complete it, go to this LINK to download and print your form and fax it back to CannMedLive or email it to register@cannmedlive.com

It is best to complete this form on your laptop, desktop computer or iPad rather than your mobile phone.