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Complete Your 90 Day Renewal Here!
Medical Cannabis 90 day Form
ATTENTION: The EVS System allows us to renew patient cards until it is within 14 days of the card expiring.
Please do not submit for your 90 day card renewal unless it is within 14 days of your Medical Cannabis card expiring. Thanks!
Date of Birth
Date Format: MM slash DD slash YYYY
Please select your QMP
Please list your qualifying condition that you've been approved for
Please list all forms of cannabis have you used or tried in the last 90 days
Frequency you consume/administer cannabis per day
Strength/ dosing/ or strain of all medical cannabis forms you have used or tried in the last 90 days.
Please list any other symptoms or conditions (NOT INCLUDING THE STATE QUALIFYING CONDITIONS) that by using cannabis has also helped or you've experienced benefits from using cannabis.
Expiration date of current card