WeedMD Registration Form - weedmd.com/vdp-register

Getting
Started

Registration

Next
Steps

OUR FLOWER

Complete your registration below to gain access to WeedMD’s wide range of medical cannabis strains.

NOTE: If you prefer to have your products shipped to your doctor's office instead of your home address, you will need to register via the downloadable Registration Application Form. Page 3: Section B of this form must be filled out by your Healthcare Practitioner.

WEEDMD PATIENT REGISTRATION - STEP 2

YOUR CONTACT INFORMATION

Legal First Name

Middle Name

Last Name

Date of Birth

Gender

Primary Phone Number

Secondary Phone Number

Fax Number

Preferred Contact Time

YOUR ADDRESS

Address Line 1

Address Line 2

City

Province

Postal Code

Are you enrolled in the Veterans Affairs Canada program?

Yes

Is your residential address a private residence?

Yes, I live in a private residence

No, I live in a non-private residence

Is your shipping address the same as your home address?

Yes, my shipping address is the same as my home address

No, my shipping address is not the same as my home address

Are you the Applicant or are you the individual responsible for the Applicant?

I am the Applicant

I am the individual responsible for Applicant

Is your WeedMD registration being supported by a copy of a Registration Certificate (to grow your own cannabis for medical purposes) issued by the Minister made under Part 2?

Yes

If you are applying with a copy of the Registration Certificate, please indicate by checkbox if the application is being made for the purpose of obtaining:

An interim supply of fresh or dried cannabis or cannabis oil

Cannabis plants or seeds

Please check the shipping address to be used for the purpose of obtaining cannabis plants or seeds:

Production Site Address

Storage Address

Designated Person

Designated Person First Name

Designated Person Last Name

Designated Person Date of Birth

Designated Person Gender

Designated Person Phone Number

Designated Person Fax Number

Designated Person Email

Is your Production Site Address the same as your Primary Address?

Yes, my Production Site Address is the same as my Primary Address.

No, my Production Site Address is NOT the same as my Primary Address.

Is your Storage Site Address the same as your Primary Address or your Production Site Address?

My Storage Site Address is the same as my Primary Address.

My Storage Site Address is the same as my Production Site Address.

My Storage Site Address is a different address.

PRESCRIPTION REMINDER PROGRAM AND PRODUCT NEWS

Yes, inform me when my prescription needs to be renewed.