I am:
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Seeking my Arkansas Medical Marijuana Certification for the First Time
Renewing my Arkansas Medical Marijuana Certification
Do you have an Arkansas State Identification?
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Yes
No
Unfortunately, the state of Arkansas will not allow you to have an Arkansas Medical Marijuana Card if you do not have a valid AR State ID
Please Select Your Qualifying Condition(s)
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Cancer
Glaucoma
HIV/AIDS
Hepatitis C
Amyotrophic lateral sclerosis
Tourette’s syndrome
Crohn’s disease
Ulcerative colitis
PTSD
Severe arthritis
Fibromyalgia
Alzheimer’s disease
Cachexia (wasting syndrome)
Peripheral neuropathy
Intractable pain
Severe nausea
Seizures
Muscle Spasms
Please Choose from the following
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I will upload documentation of my PTSD
I will take the FREE PTSD self test to serve as documentation of my PTSD
I have already taken the free PTSD Self Test
Please click the link above and complete our free PTSD self test, which we will use as your documentation of PTSD. Once you've completed the Free PTSD Self Test, you can then return to schedule an appointment!
Has your pain been ongoing for six months or longer?
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Yes
No
Unfortunately pain must be ongoing for six months or longer to qualify as chronic pain. Please choose a different Diagnosis on the next screen
Would you like to upload documentation of your qualifying condition?
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Yes
No
Upload patient history documentation or photographs of medications
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Please provide a detailed description of the medical history surrounding your condition(s). Try to be as specific as possible and include the time frame your condition began.
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I certify that the information provided here is true, and accurate to the best of my knowledge
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Yes
Patient First Name
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Patient Last Name
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Preferred Name
Patient Gender
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Male
Female
Other
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Date of birth
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Phone
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Email
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Address
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City
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State
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Postal code
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Do you have a history of tobacco use?
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Yes
No
Do you currently use tobacco?
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Yes
No
Are you currently taking any medication?
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Yes
No
Please list any medication you are currently taking
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How did you hear about us?
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Google
Facebooks
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Satisfied Customer
Other
How did you hear about us?
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Terms and Conditions
I agree to comply with the terms of use
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Yes