ONLINE CLIENT REGISTRATION

IMPORTANT: DO NOT FILL OUT AND SUBMIT THIS FORM UNTIL AFTER YOU HAVE SEEN YOUR HEALTHCARE PRACTITIONER.

PLEASE FILL IN ALL REQUIRED FIELDS. THIS INFORMATION WILL BE SUBMITTED TO OUR CLIENT SERVICE EXPERTS WHO WILL FOLLOW UP WITH YOU REGARDING THE STATUS OF YOUR REGISTRATION. For clients with a non-permanent address, we require you to fill out a separate form.

PLEASE NOTE: this begins your registration process with canna farms. However, submission of an original medical document (via mail or secure fax) from your healthcare practitioner (hCP) is still required to finalize your registration.

IF YOU HAVE ANY QUESTIONS THEN PLEASE CONTACT US FOR MORE INFORMATION!

APPLICANT INFORMATION
New clients have never been registered with Canna Farms; renewals are for previously-approved clients that have a new authorization from their HCP.
ACMPR Supply of Starting Materials (Live Cannabis Plants)
IMPORTANT: PLEASE READ THIS ENTIRE SECTION AND DO NOT CHECK THE BOX UNLESS YOU HAVE BEEN APPROVED BY HEALTH CANADA FOR PERSONAL CANNABIS PRODUCTION, AND HAVE A COPY OF YOUR REGISTRATION CERTIFICATE IN HAND AND READY TO SUBMIT TO US. Under Section 130(1)(g) of the ACMPR, persons seeking to purchase live marihuana (cannabis) plants must indicate this on the Canna Farms Registration Form. Please note that this does NOT apply to the majority of new/existing client registrations. Do NOT check this box unless you have been given explicit instructions by a Canna Farms customer service expert to do so.
ACMPR Interim Supply of Dried Cannabis / Cannabis Oil
IMPORTANT: PLEASE READ THIS ENTIRE SECTION AND DO NOT CHECK THE BOX UNLESS YOU HAVE BEEN APPROVED BY HEALTH CANADA FOR PERSONAL CANNABIS PRODUCTION, AND HAVE A COPY OF YOUR REGISTRATION CERTIFICATE IN HAND AND READY TO SUBMIT TO US. Under Section 130(1)(g) of the ACMPR, persons seeking an interim supply of dried cannabis/cannabis oil must indicate this on the Canna Farms Registration Form. Please note that this does NOT apply to the majority of new/existing client registrations. Do NOT check this box unless you have been given explicit instructions by a Canna Farms customer service expert to do so.
Please note that we require an ORIGINAL MEDICAL DOCUMENT from your Healthcare Practitioner (HCP) to be able to complete your application. We recommend that new clients do NOT submit a registration form until after they have consulted with their HCP and have been authorized a certain dosage of cannabis (in grams per day).
Applicant's Name *
Applicant's Name
Your full legal name is required for us to process your registration.
Applicant's Date of Birth *
Applicant's Date of Birth
Applicant's Physical Address *
Applicant's Physical Address
Please fill in your current legal physical address. Please note that P.O. Boxes are not accepted in this section. If you are SHIPPING to a P.O. Box, then please provide the information in the 'SHIPPING INFORMATION' section below. ADDRESS 1 = Your Street Address (e.g., 1234 High Street); ADDRESS 2 = Apartment/Unit/Buzzer Number (if applicable)
Applicant's Phone Number *
Applicant's Phone Number
Veterans only: please provide us with your Veterans Affairs K Number
SHIPPING INFORMATION
Please note that live marihuana (cannabis) plants may only be shipped to the address stated on your personal production license.
Shipping Address
Shipping Address
Please complete if your shipping address is different than the address provided above. Please note that live marihuana (cannabis) plants may only be shipped to the address stated on your personal production license. ADDRESS 1 = Your Street Address (e.g., 1234 High Street) OR P.O. Box; ADDRESS 2 = Apartment/Unit/Buzzer Number (if applicable).
INDIVIDUAL RESPONSIBLE FOR APPLICANT (IF APPLICABLE)
To be completed by the individual responsible for the applicant. The responsible individual may act on behalf of the registered client. They may make inquiries, changes and orders on the part of the client
Responsible Individual's Name
Responsible Individual's Name
Responsible Individual's Date of Birth
Responsible Individual's Date of Birth
Responsible Individual's Phone Number
Responsible Individual's Phone Number
AUTHORIZATION
Must be signed by the Responsible individual.