A Caregiver Can Help You to Get Edibles

Complete the Form Below to Get Started

Cannabis Caregiver Request Form

A caregiver is a person or group that is permitted to grow cannabis on your behalf for medical purposes, but also includes the ability to convert medical marijuana into specific concentrates or edibles. If you are somewhat confused by the options available to you, we can connect you with one of the trusted and reputable caregiver organizations that we collaborate with. Upon submitting this request, you will be contacted within 24 hours by a caregiver representative that will walk you through the quickest way to get edibles.

Caregiver Application Process Step1

Please Complete the Following Questions

Confirm Personal Status

Are you a Canadian resident?

 Yes No

Are you at least 18 years of age?

 Yes No

Are you a Military Veteran?

 Yes No

Do you have a valid provincial health card?

 Yes No

Do you suffer from any of the following medical conditions?

 ADD Chronic Pain Insomnia ADHD Crohn's Disease Irritable Bowel Syndrome Anxiety Degenerative Diseases MS Arthritis Depression Panic Attacks Asthma Epilepsy Parkinson's Disease Autism Fibromyalgia PTSD Brain Injury Glaucoma Seizure Disorders Cancer Hepatitis C Sleep Disorders Chronic Nausea HIV/AIDS Other (please specify)

Can you list any past or present medications and/or treatments?

Do you happen to have any of the following medical documents?

 Letter of Diagnosis Previous Prescription for Medical Cannabis X-Ray Previous Prescription for Current Ailment MRI Record of Previous Doctors Visit Sympton-Ailment Report NO or Other (fill in box below)

Please specify your primary interests

 Getting Licensed Access to Edibles Access to Medical Flower Access to Oils & Concentrates Other (please specify)

Do you have experience with dispensaries?

 Prefer buying from a dispensary OK with dispensaries but prefer Health Canada regulated cannabis Will not buy from a dispensary Other (fill in box below)

Contact Information

First Name

Last Name

City or Location

Telephone

Email

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