Schedule an Appointment

SCHEDULE AN APPOINTMENT

If you are a first time patient, or returning to Green Health please fill out this form to schedule an appointment. We will contact you right away.

Name *:

Last Name:

D.O.B.:

Phone:

Email:

Required Service:

Conditions/Complaints:

Check the box if you have been seen by Doctor for this condition in the last 3 years


* These fields are required.

What Medical Conditions Can Disqualify a Driver?
You qualify for a medical marijuana card if you have the following conditions and consequent symptoms:

Conditions

Cancer

HIV Infection or AIDS

ALS

Parkinson’s Disease

Multiple Sclerosis

Spinal Cord Injury with Spasticity

Inflammatory Bowel Disease

Neuropathies

Huntington’s Disease

Epilepsy

Chronic Pain

Symptoms

Cachexia or Wasting Syndrome

Severe or Chronic Pain

Severe Nausea

Seizures

Severe or Persistent Muscle Spasms