Minnesota Medical Cannabis Program

Please fill out this simple form to contact us and determine your eligibility for the Minnesota Medical Cannabis Program. Our staff will contact you via phone within one business day. If you are eligible for the program we will talk to you about scheduling an appointment for an evaluation with one of our providers. Note: you have to be a MN resident to qualify for medical cannabis in MN

* required fields

Name*

Phone*

Email*

Date of Birth*

Please check which of the following medical conditions you are seeking treatment for: (You must have one of these conditions to qualify for medical marijuana in Minnesota.)

Looking for treatment for the following Conditions *

Cancer
Alzheimer’s disease
Chronic Pain
Intractable Pain
Inflammatory Bowel Disease
PTSD
Autism
Sleep Apnea
ALS
HIV/AIDS
Epilepsy
Crohns’ Disease
Glaucoma
Multiple Sclerosis
Lou Gehrig’s Disease
Seizures
Muscle Spasms
Terminal Illness
Tourette’s Syndrome