4201 Excelsior BLVD, Saint Louis Park, MN 55416

Tel. 952-933-g900 Fax 952-945-9536


Dear medical cannabis applicant,Please read and sign below indicating your understanding of the conditions of the service you
have requested
• Our doctor will evaluate your case for the purpose of certifying you for medical cannabis in the state of Minnesota according to the rules published on the Minnesota Department of Health Office of Medical Cannabis website. This means that the doctor will establish whether you have one of the qualifying conditions and certify you on the website. You will not get any card or certificate from the doctor. You will get an email from the Health Department with further instructions. Once the Health Department approves you, you will get all the necessary documentation from them.
>>By certifying you on the MDH website the doctor does not make any recommendations on cannabis use, does not prescribe cannabis and does not make any claims about its safety or effectiveness in any condition. The prescription will be made by the pharmacist in one of the dispensaries approved by the MDH. The doctor only certifies that you have one of the qualifying conditions.
• The fee for this service to our clinic is $250.00. There are no discounts. This fee covers the certification process only. It does not cover any other services provided during the visit, such as possible tests, other medical advice, treatments, etc. Some of the other services may be billed to your medical insurance at the time of the visit. Regardless of your insurance policy, you will not be expected to pay any more out of pocket for this visit. This fee has nothing to do with the fee charged by the Minnesota Department of Health for their approval process.
• Minnesota law requires that the doctor providing medical cannabis certification also provides primary care for the qualifying conditions s/he certifies you for. This means that the doctor may offer some additional evaluation and treatment for these conditions, which you are not obligated to accept. The doctor will also suggest periodic follow-up in person or via video link.
• Cannabis may impair coordination and cognition, ability to drive, operate heavy machinery and engage in potentially hazardous activities.