urgent care

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