MA Card

Do You Qualify

Just fill out the form on this page to Pre-Qualify for your Massachusetts Medical Marijuana Card

Fill out the form below to begin pre-qualifying for your medical marijuana card.

A representative from Massachusetts Marijuana Doctors will contact you shortly to obtain your medical records, pre-qualify your condition, and setup an appointment for you to see the doctor.

Click here to view the entire process that is required to get a medical marijuana card.

*(denotes required field)

First Name: *
Last Name:*

E-Mail Address:*

Your Phone Number:*

Are you a resident of Massachusetts?*

 Yes

 No

Do you have a valid Massachusetts Driver’s License of ID? *

 Yes

 No

Are you at least 18 years of age?*

 Yes

 No

Do you currently have medical records diagnosing your condition?*

 Yes. I have them in my possession.

 Yes. But my doctor has them.

 Yes. But I am not sure where they are located.

 No. I do not have any medical records.

Which of the following qualifying conditions do you have?*

 Crohn’s Disease

 Glaucoma

 Parkinson`s

 HIV

 AIDS

 Hepatitis C

 Agitation of Alzheimer’s Disease

 Amyotrophic Lateral Sclerosis (ALS)

 Multiple Sclerosis

 Other Conditions determined in writing by a qualified physician:

 Chronic Pain of at least 6 months duration

 Chronic muscle spasm

 Cachexia (wasting syndrome)

 Agitation of Alzheimer’s disease

 PTSD

 Painful peripheral neuropathy

 Terminal illness (hospice care)

 Radiculopathy

 Degenerative Arthritis

Approximately when did your condition begin?*

Are you currently receiving treatment for this condition?*

 Yes

 No