Is Medical Marijuana Right for you?

Please fill this form out to the best of your ability and the staff at the Office of Dr. Moskowitz will get in touch with you within 24 hours. We look forward to working with you on your journey to health and relief! 
Mark the medical conditions that apply to you or the patient
Chronic Pain
HIV infection or AIDS
Amyotrophic Lateral Sclerosis (ALS)
Parkinson's Disease
Multiple Sclerosis
Inflammatory Bowel Disease (IBD)
Huntington's disease.
Do you have a history of any of Psychosis, schizophrenia or unstable psychiatric disease such as manic depressive illness *

Personal Information


Medical Files - Upload Medical Documents

Do you have Medical Records that discuss your medical diagnosis/condition *

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