Massachusetts Medical Marijuana Card Application

We will review your information and help you qualify for the Massachusetts Medical Marijuana Program. All of your information is strictly confidential and will be used explicitly for the application process. There are 4 steps that will determine your eligibility. This should take no more than 5 minutes. By submitting this application you understand that we will contact you with your results and to schedule your appointment. Please allow 3 business days for us to review your application and create your wellness plan for your medical marijuana card.

WARNING: If you dont provide an ACCURATE phone number & e-mail, we cannot contact you with your results.

Contact Information
First Name:
Last Name:
Phone:
Email:
City:
Zipcode:
Step 1 - Basic Qualifications
Are you 18 or older?
If not 18, you must have a parents signiture on the final application. If you have your parents permission, click "yes" to this questions to submit.
Drug related felony within 5 years?
The OMMP may not grant you a medical marijuana card if you have been convicted of manufacturing or distributing marijuana within 5 years.
Do you have a valid ID?
Sorry you must have a valid state ID
Step 2 - Qualifiying Medical Conditions
Which of the following conditions will you treat with medical marijuana?
Severe Pain  
Nausea  
Muscle spasms  
Multi. Sclerosis  
Cachexia  
Cancer  
Glaucoma  
HIV+/AIDS  
Seizures  
Epilepsy  
Alzheimer's  
Step 3 - Medical Records
Have you visited a MD to discuss your current symptoms within 1 year?
Do you have at least 2 documented MD visits stating your condition?
Do you have copies of these medical records?
Step 4 - Doctor Recommendation
Schedule an appointment to get your doctors recommendation at our marijuana clinic.
Which clinic location is most convenient for you?
Appointment Preferences
Monday AM  
Monday PM  
Tuesday AM  
Tuesday PM  
Wednesday AM  
Wednesday PM  
Thursday AM  
Thursday PM  
Friday AM  
Friday PM  
Weekend AM  
Weekend PM  


We will call you after we review your info to schedule your appointment!