Ready to become a client?
Now that you've created your account, just complete this registration form
online or download a copy to print and fill out.
Applicants in the care of responsible individual(s), who wish to have their product shipped to their health care
practitioner, or who do not have a permanent residential address (currently reside in a shelter, hostel, or similar
institution) can access expanded application forms here or contact client services at 1-866-488-4525 or
firstname.lastname@example.org for assistance.
You're almost done! The last step is to have your health care practitioner fill out
and sign your medical document.
Please note this document must be filled out in its entirety and signed by your health care practitioner.
We can only accept original documents by mail, or a secure fax from the office of your health care practitioner.