SCHEDULE AN APPOINTMENT

Schedule Appointment

Type of Visit*

Office Location*

Reason for Visit

Patient Name*

First

Last

Date of Birth*

Email*

Home Phone

Cell Phone*

Residency

Full-Time Florida Resident

Seasonal Florida Resident

Diagnosed Condition*

Do you have Medical Records?*

Yes

No

This field should be left blank

By completing this form, you acknowledge that Marijuana Care Clinic may contact you via phone and/or email.

Disclaimer: You certify that the information provided is correct to the best of your knowledge and understand that to falsify information is grounds for denial of certification. Completing this form in no way constitutes approval of a medical marijuana certification. You further acknowledge acceptance of a solicitation from Marijuana Care Clinic in regards to medical marijuana.

Qualifying Conditions

Patients in Florida diagnosed with one of the following debilitating medical conditions, are afforded legal protection under the Florida Medical Marijuana Legalization Initiative, Amendment 2.

ALS/LOU GERIGS DISEASE
ANOREXIA*
ANXIETY *
ADULT ADHD *
ARTHRITIS*
BIPOLAR DISORDER WITH ANXIETY OR DEPRESSION*
CANCER
CHRONIC BACK PAIN*
CHRONIC NONMALIGNANT PAIN
CROHNS DISEASE
DIABETES MELLITUS 1
DIABETIC NEUROPATHY*
DEPRESSION*
EPILEPSY
FIBROMYALGIA*
GLAUCOMA
HEPATITIS C*

HIV/AIDS
INSOMNIA*
IRRITABLE BOWEL SYNDROME
LUPUS*
MIGRAINE HEADACHES*
MULTIPLE SCLEROSIS
OSTEOARTHRITIS*
PARKINSONS DISEASE
POST TRAUMATIC STRESS DISORDER (PTSD)
RADICULITIS*
RHEUMATOID ARTHRITIS*
SICKLE CELL ANEMIA*
TERMINAL ILLNESS
ULCERATIVE COLITIS*
Or any other ailment/condition of the same severity/symptoms, when determined by a physician’s opinion that the medical use of marijuana would surpass any potential health risks

* Denotes ‘Medical Conditions of same kind or class as or comparable to the above qualifying medical conditions.

PRICING PLANS

New Patient Visit

Pre-paid with non-refundable deposit

$179

Includes all routes of administration: Smokable, Inhalation, Oral, Suppository, Topical, Edible and Sublingual. No Additional Costs or Hidden Fees! Save $20.00 with this option!!! By securing your appointment with a non-refundable deposit, you save $20. This helps manage our schedule better, and don't worry, we Guarantee Approval or 100% Money Back. This service includes your required medical exam with our Certified and Licensed Marijuana Doctor, plus all refills and dosage adjustments for the state maximum allowed 7 months. Our highly experienced staff will also help first time patients with their state application. A $50 non-refundable deposit will be applied to balance. Deposit is only forfeited with missed appointment without 24 hours' notice. One rescheduled is allowed. (State Application fee not included.)

Follow Up and Transfer Visits

Pre-paid with non-refundable deposit

$149

Includes all routes of administration: Smokable, Inhalation, Oral, Suppository, Topical, Edible and Sublingual. No Additional Costs or Hidden Fees! Save $20.00 with this option!!! By securing your appointment with a deposit, we will happily give you a nice savings. This helps manage our schedule better, and don't worry, we Guarantee Approval or 100% Money Back. This service includes your required medical exam with our Certified and Licensed Marijuana Doctor, plus all refills and dosage adjustments for the state maximum allowed 7 months. A $50 non-refundable deposit will be applied to balance. Deposit is only forfeited with missed appointment without 24 hours' notice. One rescheduled is allowed. (State Application fee not included.)

New Patient Visits

Pay in Clinic

$199

Includes all routes of administration: Smokable, Inhalation, Oral, Suppository, Topical, Edible and Sublingual. No Additional Costs or Hidden Fees! Guaranteed Approval or 100% Money Back. This service includes your required medical exam with our Certified and Licensed Marijuana Doctor, plus all refills and dosage adjustments for the state maximum allowed 7 months. Our highly experienced staff will also help first time patients with their state application. Cancellation and/or no-show fee of $25 if cancelled within 24 hours of scheduled appointment or patient no-shows. (State Application fee not included.)

Follow Up and Transfer Visits

Pay in Clinic

$169

Includes all routes of administration: Smokable, Inhalation, Oral, Suppository, Topical, Edible and Sublingual. No Additional Costs or Hidden Fees! Guaranteed Approval or 100% Money Back. This service includes your required medical exam with our Certified and Licensed Marijuana Doctor, plus all refills and dosage adjustments for the state maximum allowed 7 months. Cancellation and/or no-show fee of $25 if cancelled within 24 hours of scheduled appointment or patient no-shows. (State Application fee not included.)