Patient Registration

Tip: Before you begin filling out this form, scan or take a picture of your medical marijuana ID card and patient certification form. If you have a temporary medical marijuana ID card, you will need a copy of the temporary card and patient certification form ready for upload.

What type of card do you currently have?

NY Registry Identification Card (Front) -

Please upload a picture of the front of your Medical Marijuana Program Registry Identification Card mailed to you by the NYS Department of Health

No file attached Attach file

NY Registry Identification Card (Back) -

Please upload a picture of the back of your Medical Marijuana Program Registry Identification Card mailed to you by the NYS Department of Health

No file attached Attach file

NY Temporary Medical Marijuana card -

Please upload a scanned image or picture of the Printed Temporary Medical Marijuana Card

No file attached Attach file

NY Patient Certification (1 page) -

Please upload a scanned image or picture of the signed patient certification from your physician

No file attached Attach file

Have you previously purchased a product from Vireo?

If you are a first-time patient at Vireo, please schedule a 'First-Time Patient Consult' with our Pharmacy staff after your online registration. Both in-person and virtual (using Skype) consults are available. For more information, please visit vireohealth.com/ny/make-an-appointment/.

Do you have a registered caregiver?

If you have a caregiver, please provide us with the caregiver's name in the bottom box of this form.

How did you hear about us?

I’d like to receive promotional messages via text/SMS.

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I accept the Vireo Terms of Service

Vireo Terms of Service:

By registering for an online account, I agree to receive emails from Vireo Health regarding my account status, orders, and promotions. We do not share or sell information to third-parties. View our Privacy Policy.