Medical Marijuana Card Registration Requirements

Medical Marijuana Registry Application Process • Patient completes application • Physician confirms condition • Cost: $90 per year • Registry verifies physician licensure • Card must be renewed each year • All information is maintained in a confidential database To register with the Colorado Medical Marijuana Registry interested applicants must send in a signed physician referral form and complete and sign a registry application form. Colorado Medical Marijuana Card Registration Requirements follow. • Completing an application form for a medical marijuana registry (ID) or identification card • Sign and date the registry application form • Have the physician sign and date the physician recommendation form • Photocopy a legible copy of an approved photo I.D. that establishes Colorado residency. • Send in a non refundable application fee of $90 (check or money order payable to (CDPHE) • Send all of the items above to: Documentation of condition • Bona fide patient/physician relationship • Physician, MD or DO, in good standing, licensed to practice medicine in the state of Colorado Colorado Department of Public Health and Environment or (CDPHE) http://www.cdphe.state.co.us/ care of the Colorado Medical Marijuana Registry 8100 East Lowry Boulevard Denver, CO 80230-6923 Medical Marijuana Registry Contact Information Debra Tuenge debra.tuenge@state.co.us www.cdphe.state.co.us/hs/medicalmarijuana/marijuanafactsheet.html 303-692-2184 phone 303-691-7945 fax