Qualified Physician Visit & Patient Certification Form

Meet with a qualified physician, physician’s assistant, or nurse practitioner to discuss the use of medical marijuana and confirm your diagnosis. If they agree to approve you for the program, they must submit a patient certification form on your behalf.

Qualifying Medical Conditions

Any condition for which an opioid could be prescribed • ALS • Cancer • Chronic Pain • Epilepsy • HIV/AIDS • Huntington’s Disease • Multiple Sclerosis • Neuropathy • Parkinson’s Disease • PTSD • Spinal Cord Injury with Spasticity


Complete Online application

• Create an account at NY Government website and click on “Health Applications” then “Medical Marijuana Data Management System” in order to access the online application form. If your application is approved, you’ll receive your medical marijuana card in the mail. Additionally, you can ask your doctor’s office to do this (in fact, most doctors will include this in price of the consultation).


Proof of Residency

Acceptable Forms

  • ID number from your NY Driver’s License or NY Non-Driver ID Card.
  • Copy of a government-issued identification card
  • Copy of a utility bill or other document showing your residency issued within the previous two months
  • Copy of a current lease or similar document


Once you’ve submitted your information, it will typically take the standard 7-10 business days (if approved) for your medical marijuana card to arrive in the mail, at which point you can purchase legal marijuana from a qualified New York state dispensary.