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Oklahoma - Addon Upload Assistance for state application for Adult, Pediatric or Caregiver

$50

$28

*100% secure & safe payments*

If you need assistance with your OMMA application, upload of forms, pictures, doctor info, all data entry functions, then this is needed. The Dr Only is just the form, you would need to fill out the OMMA portal yourself to get your medical card approved.

Upload Assistance Addon

If you need assistance with your OMMA application, upload of forms, pictures, doctor info, all data entry functions, then this is needed. The Dr Only is just the form, you would need to fill out the OMMA portal yourself to get your medical card approved.

Form Correction

Submitted an intake form but found errors in your doctor form? This service lets our staff handle the corrections for you. A correction fee applies.

Form Correction

Oklahoma- Form Correction

Submitted an intake form but found errors in your doctor form? This service lets our staff handle the corrections for you. A correction fee applies.

$9.99

*100% secure & safe payments*

Submitted an intake form but found errors in your doctor form? This service lets our staff handle the corrections for you. A correction fee applies.

LET'S CHECK YOUR EMAIL FIRST

Email Duplicate Lookup

The email is already saved in our patient records.

OTP Checker

123456

Please enter your email to proceed.

Email *

PATIENT INFORMATION

First Name *

Middle Name

Last Name *

Suffix

Email *

Phone (Unique number must be used for each account) *

Birth Date Month *

Month

January
February
March
April
May
June
July
August
September
October
November
December
No elements found. Consider changing the search query.
List is empty.

Birth Date Day *

Day

Birth Date Year *

Year

Age *

Gender *

Gender

Male
Female
Other
No elements found. Consider changing the search query.
List is empty.

Select Ethnicity *

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native

White

How Did You Hear About Us? *

How Did You Hear About Us?

Facebook
Website
Word of Mouth
Instagram
Google Search
Tiktok
TV Commercial
No elements found. Consider changing the search query.
List is empty.

Street Address Only (DO NOT INCLUDE CITY, STATE, COUNTRY) *

City *

Postal code *

Apartment #

County *

Select Your County

IDENTIFICATION

ID Type *

Driver's License

State ID

Tribal ID

US Passport

ID Number *

MEDICAL INFORMATION

Have you been evaluated and denied a medical cannabis recommendation? *

Yes

No

Are you currently under the care of a physician? *

Yes

No

Have you ever been hospitalized? *

Yes

No

Have you been evaluated for the use of medical cannabis by any other physician in the past? *

Yes

No

Immediate family medical issues (Indicate if you or your immediate family had any of the following problems) *

None

Kidney Disease

Liver Disease

Migraines

Seizures

Alzheimer's disease

Arthritis

Asthma

Blood disorders

Cystic fibrosis

Dementia

Depression

Diabetes

Heart Attack

Heart Disease

High Blood Pressure

High cholesterol

Others

Have you ever been treated for symptoms of depression, psychosis, attempted suicide or had any other mental health issues? *

Yes

No

Have you ever been prescribed medication for any mental health problem? *

Yes

No

Do you currently see a mental health physician? *

Yes

No

PATIENT MEDICAL HISTORY

Are you currently employed? *

Yes

No

Social Questions

Do you drink alcohol? *

Yes

No

Do you smoke cigarettes? *

Yes

No

Do you have a history of drug abuse? *

Yes

No

*Please check your email for an additional requirements.

I confirm that I have read and agree to the Terms & Conditions. I acknowledge that all data entered is 100% accurate, and I understand that a $9.99 form correction fee will apply if changes are required after submission.

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**THE ZIP MUST MATCH THE BILLING ZIP ON CARD**

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Contact

866.405.WEED (9333)

Mon - Fri 12PM to 6PM

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