Delaware Medical Marijuana Patient Application

Form Template

For patients with severe nausea, chronic pain, a debilitating disease, muscle spasms, or with a mental ailment such as post-traumatic stress disorder, a health care professional may recommend medical marijuana for effective treatment of these conditions.

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In order to obtain cannabis products, the patient must be enrolled in a medical cannabis program and receive an identification card to present at the designated marijuana dispensary. With the Delaware Medical Marijuana Patient Application app, a patient can apply for a medical marijuana program and be issued a medical marijuana card. With the patient’s attestation statement, the applicant will acknowledge risks of using these controlled substances and agree to the terms required by local marijuana laws. The form solicits contact information from both patients and caregivers, if applicable. The app includes a physician certification describing the health condition requiring treatment. With the final checklist, a medical marijuana patient will ensure they submit all necessary information to be added to a medical marijuana registry, receive a marijuana card, and begin treatment for their medical condition or conditions.

Features
  • Signature Capture
  • GPS
  • Image Capture
  • Conditional Fields
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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