Please upload below or confirm you will text or email, your Photo ID: Photo Driver's License/State ID to either our HIPAA protected #: (318) 344-4890 telephone or email: email@example.com
State Issued Identification Card, DL or Passport
Telehealth calls must be HIPAA compliant.
Medical M A R I J U A N A Pharmacy of Choice (you may change your Pharmacy at ANY time)
A Delegate is a person who can legally pick up your medicine for you. This is not a person you are declaring can have your personal health information, just a person you trust to pick up your prescription if you cannot. You may change or add delegates at any time. You may also leave this blank if it does not apply to you.