New Patients


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New Member Registration

Please fill out the form below to become a patient of our services. All fields are required unless otherwise indicated. Your doctor recommendation must be verified. Verification may take up to 24 hours depending on your doctors availability. Once your recommendation is verified you will receive a email notification. Final verification will be complete on first visit. To complete registration an original of your doctors recommendation and a valid California ID is required. Thank you.

Your Information

First Name:
Last Name:
Address:
City:
State:	CA
Zip Code:
Phone Number:
E-mail Address:
Date of Birth:

Doctor Information

Doctor's Name:
Doctor's Phone Number:
Referral Expiration Date:
Cannabis Card ID # (optional):

Caregiver Information (if applicable)

Yes, I have a caregiver.

Caregiver's Name:
Caregiver's Date of Birth:
Caregiver's Phone Number:

Authorization for Cannabis Use

Please read the following terms and conditions:
Designation of Primary Caregiver As per California Health and Safety Code §11362.5 I hereby certify that I am a Patient suffering from serious illness and have obtained a recommendation or approval from a licensed physician in the state of California to use medical cannabis (marijuana) in treating my illness. A copy of my recommendation may be attached hereto. I hereby designate Los Angeles Cannabis Club as my “Primary Caregiver,” in accordance with California Health and Safety Code §11362.5(d) and §11362.5(e), which reads as follows: (d) Section 11357, relating to the possession of marijuana, and section 11358, relating to the cultivation of marijuana, shall not apply to a patient, or to the patient’s primary caregiver, who possesses or cultivated marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician. (e) For the purposes of this Section, ‘primary caregiver’ means the individual designated by the person exempt under this act who has consistently assumes responsibility for the housing, health or safety of that person. I agree I will consistently rely on Los Angeles Cannabis Club and More as the primary source of medical cannabis as a matter of my personal health and safety. This designation shall remain in effect (1) for one year from the date below, (2) until I revoke this designation, (3) until I designate another individual as my primary caregiver, or (4) upon expiration of my physician’s recommendation. I authorize my recommending physician to verify his or her recommendation or approval for the use of medical cannabis. I will not use this medication with alcohol or other mind altering medications. I will not drive or operate heavy machinery.

I hereby agree to the above terms and conditions. NOTE: Upon delivery of your first order, you will be required to sign a consent form, as well as furnish a government issued photo ID and your original doctors recommendation.

Once you have filled out the above information, press Register.

If you have any questions or need to contact us directly click here.