Is Medical Marijuana Right for you?

Mark the medical conditions that apply to you or the patient
 -
Chronic Pain
Cancer
HIV infection or AIDS
Amyotrophic Lateral Sclerosis (ALS)
Parkinson's Disease
Multiple Sclerosis
Epilepsy
Inflammatory Bowel Disease (IBD)
Neuropathies
PTSD
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

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Medical Files - Upload Medical Documents

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

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