Is Medical Marijuana Right for you?

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.
Are you currently suffering from a medical condition that will qualify you for the New York Medical Marijuana Program
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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