Get a Card
Application for Compassionate Delivery
Indicates required field
Date of Birth (mm/dd/yyyy)
Upload Driver License
Max file size: 20MB
CA Driver License / ID #
Upload Doctor's Recommendation
Max file size: 20MB
Recommendation ID / Verification ID #
Physician's License #
Terms and Conditions
By completing this form you are agreeing to and acknowledging the following:
You are an adult California resident qualified patient or primary caregiver.
You have a serious medical condition and possess/cultivate cannabis for the personal medical purposes of a patient upon the written or verbal recommendation or approval of a physician. You have not had a membership in this organization terminated by removal or expulsion within the last five years, except if removed solely for non-payment of fees or dues and have since paid all sums past due.
You have not had a membership in any other medical cannabis cooperative or collective terminated or been expelled for cause within the last five years in any other medical cannabis cooperative, except if removed solely for non-payment of fees or dues.
You have not been convicted of any
felony within the last 5 years, including violation of Section 11351, 11351.5, 11352, 11355, 11359, 11360, 11378, 11378.5, 11379, 11379.5, 11379.6, 11380, 11382, or 11383 of the Health and Safety Code, or Section 182 of the Penal Code, or a felony violation of Health and Safety Code Section 11366.8, insofar as the offense involves manufacture, sale, possession for sale, offer for sale, or offer to manufacture, or conspiracy to commit one of those
or a like offense from another jurisdiction.
You are applying to be a member of Patio Health and Wellness Services. If accepted as a member, you must agree to the terms and conditions of membership as set forth in this agreement and the Bylaws. You acknowledge that you have read the terms and conditions, have read the Articles and Bylaws which are on public display in the Collective, and are aware of the legal consequences of this agreement and membership, including that you are prevented from suing the Collective or its employees, agents or officers if you are injured or damaged for any reason as a result of participation as a member and/or in any membership activity and/or a result of use or possession of products (including cannabis) received as a member. The Bylaws give you certain membership rights and obligations. You may have a copy of this agreement and the Articles and Bylaws at any time. READ: PATIO HEALTH AND WELLNESS TERMS AND CONDITIONS
Do you Agree to the Terms
Need a Medical Cannabis Recommendation or Renewal?
Click below to schedule
your online appointment.