Online Intake Forms

PA Medical Cards

Medical Marijuana Certifications, LLC

State Approved Marijuana Doctors

Serving All PA Residents

Our Online Intake Forms

 

You will need to complete a brief patient intake form including your contact information, your qualifying condition and any questions you may have concerning medical marijuana as a prescription medicine. Your answers will be sent to our HIPAA compliant office and will be ready for your scheduled doctors appointment. At the end of this form, you will need to schedule your appointment through our Booking App. A Video link will be sent to you after payment which you will use to meet with your PA medical marijuana doctor.

Telemedicine Intake Form

MEDICAL MARIJUANA CERTIFICATIONS, LLC.

Our patient intake form including your contact information, qualifying condition and any questions you may have concerning medical marijuana as a prescription medicine. Your answers will be sent to our HIPAA compliant office and will be ready for your scheduled doctors appointment.

Opioid Use Disorder DSM-5

DSM-5 Criteria for Diagnosis of Opioid Use Disorder. Diagnostic Criteria* These criteria not considered to be met for those individuals taking opioids solely under appropriate medical supervision. Patients who are prescribed opioid medications for analgesia may exhibit these two criteria (withdrawal and tolerance), but would not necessarily be considered to have a substance use disorder. (Reference: American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5.™ 5th ed. Arlington, VA: American Psychiatric Publishing, Inc.)

PTSD DSM-5

Below is a list of problems that people sometimes have in response to trauma and life-threatening situations. Please read and answer carefully. Base your answers on the last 30 days. When you hit “Submit” we will get a copy of your results. One of our state approved doctors will confirm whether you qualify for PTSD diagnosis, If you do, it could be part of the doctors certification decision and part of your current medical record. NOTE: IF YOU ALREADY HAVE BEEN DIAGNOSED WITH AN PTSD OR ANXIETY DISORDER AND YOU HAVE MEDICAL RECORDS YOU DO NOT NEED THIS SERVICE.

Anxiety Disorder DSM-5

Below is a list of problems that people sometimes have in response to trauma and life-threatening situations. Please read and answer carefully. Base your answers on the last 30 days. When you hit “Submit” we will get a copy of your results. One of our state approved doctors will confirm whether you qualify for an Anxiety Disorder diagnosis, If you do, it could be part of the doctors certification decision and part of your current medical record. NOTE: IF YOU ALREADY HAVE BEEN DIAGNOSED WITH AN PTSD OR ANXIETY DISORDER AND YOU HAVE MEDICAL RECORDS YOU DO NOT NEED THIS SERVICE.

Don't Forget...

Don’t Forget To Register With The State PA Medical Marijuana Program

Medical marijuana ID cards are issued by the Department of Health. You must register with the state using your driver’s license or photo ID number. Their system instantly verifies and gives you a MMP patient ID number.

At your appointment, our doctors will update your record to certify that you have been seen and approved for medical marijuana/cannabis treatment.

You are responsible to log back into the Department of Health medical marijuana patient registry and pay with a credit or debit card. This activates their system to create and ship your ID card in the mail.

The hardest part is waiting to get it!