All patients must submit an “Application for Registry Identification Card for Qualifying Patients” in addition to the “Physician Written Certification Form” that our doctors must submit to the Illinois Department of Public Health. Our staff will explain the patient application process and will ensure that every one of our patients submits a complete application along with all other items that are required by the state, which include:

• Proof of residency
• Proof of identity
• Proof of age
• 2X2 photograph of qualifying patient
• UCIA fingerprint consent form
• Excluded offense waiver, if applicable
• Selection of medical cannabis dispensary zone
• State’s application fee

If you need any assistance with filling out your application, or would like to speak to an advocate, please contact us. We will make sure that the application process is simple and stress free for all of our patients.

Application Documents

Instructions for Patient Application.pdf

Patient Application Form

Fingerprint Consent Form 080814

Caregiver Application Form