Patient Forms

Forms & Paperwork - Joy!
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We need a complete medical record of each visit so both New Patients and Renewals have to fill out forms each visit. Adults age 18 and over are advised to bring previous medical records if they are available, but they are not generally required unless requested by our doctor. Exceptions to this are patients with PTSD and children under the age of 18. PTSD patients must have been diagnosed previously by a different doctor or mental health professional. You will need the name of the diagnosing party to qualify with this diagnoses.  Medical Records, preferably printed, from a primary care doctor or specialist are required for new to clinic patients under the age of 18.

 Click Here for HCU_Patient_FormsTopBar_2017-August These are the Healthy Choices Unlimited patient information and health history forms. They are for both Adults and Children. Please print the forms, fill them out, and bring them in for your visit.

The adult Colorado Medical Marijuana Registry application is now available Online.  Click Here https://www.colorado.gov/pacific/cdphe/apply-myself-medical-marijuana-registry  to register online with the State of Colorado Dept of Public Health and Environment.  After your doctor visit, the doctor will enter your Physicians Certification into the system for you to attach to your application and complete the process.   Click here for our  OnlineMMR-Instructions2017-CCC

If you do not use email or do not have Internet access, the paper CDPHE forms packet for new patients and renewals is so frequently changed we only link to it and hope:  https://www.colorado.gov/cdphe/medicalmarijuana

Note that the name of the dispensary you use is no longer listed on Form AP.  You will now sign a letter agreement at your dispensary to join as a member.

Caregivers must now register online for a Caregiver Identification number.  This is for both new patients and renewals, the Caregiver must register online.  There is NO paper option for Caregiver registration.  Caregivers click here https://medicalmarijuana.colorado.gov/state-co-entellitrak/page.request.do?page=page.public.careGiverRegistration

Types of Caregivers are: 1) Transporting Caregiver – An individual who accompanies you to a dispensary or purchases medicines on your behalf from a dispensary and delivers it to you.  2) Cultivating Caregiver – An individual who grows your marijuana for you and may also make it into different forms of medicine.  If you have a Caregiver, put the Caregiver Identification number they provide on the application form or online. After you add in the number, the Caregiver must login separately to thier account and accept you as a patient in the Caregiver Agreement tab.  Then, you can log back in to your patient account and complete the application process.

If you don’t know how you will be obtaining your medicine, that’s OK.  We are happy to explain the options when you are at clinic.

Many of the new Medical Marijuana Registry forms no longer require a Notary. For the forms that do, we offer notary service at all of our clinics.

For more information on the State registry forms, go to the Colorado Medical Marijuana Registry Home Page