Forms for Patients
Maine state law requires physician verification of conditions that legally qualify a patient for medical marijuana certification.

Thus, the more information you can provide us to verify your qualifications for medical marijuana, the more likely we will be able to provide you with state certification. To this end, we require all of our new patients to complete the "New patient form" below, a form that allows you to tell us how you qualify. In addition, new patients who can provide past medical records or a statement from their provider are much more likely to be rapidly certified than those who cannot. 

IMPORTANT: We do not review x-rays or records older than 5 years, laboratory results (except for hepatitis C or HIV confirmation). In other words, confirmation of your qualifying condition requires a fairly recent visit to your doctor. Records sent to us should be limited to 10 pages or less and be directly relevant to the condition you believe qualifies you for medical marijuana certification.

Past records can be obtained by signing the "Patient records form" below and delivering it to your provider, clinic, or hospital records department. 

If you are applying under the chronic pain provision, you can also speed the certification process by having any of your current or past providers complete the "Patient pain history form" below.

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