Please complete the Medical Intake form below to determine eligibility for medical marijuana certification. A member of the NYMMA team will be in touch with you shortly with more information, next steps and to schedule your video consult with the doctor when all information is received.
Please make sure all information is entered in correctly and your first and last names match the spelling on
your NYS driver's license.
This information is used to generate your MMJ certification if you are approved to be certified. Any corrections needed to be made to the MMJ certification after it is submitted, will take 1-2 weeks.