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* You must complete the Application for Identification Card form and ask your physician to complete the Physician Certification form. If the applicant is a minor or you have more questions, please contact the Registry at (303) 692-2184. * Before sending materials, please make sure your application packet is complete. Incomplete applications will be returned to the applicant.

APPLICATION FOR IDENTIFICATION CARD * Please complete the entire application form. * You may choose to designate caregiver, although you do not have to. A caregiver is defined as "a person, other than the patient and the patient's physician, who is eighteen years of age or older and has significant responsibility for managing the well-being of a patient who has a debilitating medical condition." * Complete the physician information * Sign and date the application

PHYSICIAN CERTIFICATION

* Your physician must complete and sign the physician certification form * Only an MD or DO licensed to practice medicine in the state of Colorado may sign this form * The Registry must receive your complete application within 60 days of the physician's signature A LEGIBLE PHOTO COPY OF A PHOTO ID THAT ESTABLISHES COLORADO RESIDENCY

(driver's license, state ID)

NON-REFUNDABLE $90.00 APPLICATION FEE

(check or money order payable to CDPHE)

SEND ALL OF THE ITEMS ABOVE TO:

Colorado Department of Public Health and Environment

Medical Marijuana Registry

HSVRD-MMP-A1

4300 Cherry Creek Drive South

Denver, Colorado 80246-1530

The information you provide will be verified within 30 days of receiving all the application materials. If approved, your card will be issued within 5 days after verification. The maximum time is 35 days between receipt of the completed application and issuing or denying the identification card.

The applicant will receive one card with the patient's information and caregiver information, if designated. The caregiver will not receive a card.

Keep copies of all the documents you submit to the Registry. For proof that your application has been submitted, you may want to send your application in by certified mail.

Forms are available at:

http://www.cdphe.state.co.us/hs/medicalmarijuana/marijuanafactsheet.html

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Q: How do you get a marijuana license in Colorado?
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