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.
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
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
NY Temporary Medical Marijuana card -
Please upload a scanned image or picture of the Printed Temporary Medical Marijuana Card
NY Patient Certification (1 page) -
Please upload a scanned image or picture of the signed patient certification from your physician

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/.

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

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