WASHINGTON MEDICAL MARIJUANA APPLICATION
REQUIREMENTS FOR PATIENTS:
 
*Must be a Washington resident and must submit proof of residency.  The following are acceptable documents:  copy of a WA Driver’s License, WA State ID or a copy of a gas or electric bill.   Note: Your name and current address must appear on the document you submit as proof of residency.
 
*Submit a non-refundable Application Fee of $30.00 (Cash, Money Order Payable to: Encore Wellness or Online credit card) BALANCE DUE AT TIME OF APPOINTMENT
 
* Total fees:  New Cards $185   Renewal $165
Application Type *
Medical Documentation: (Chart notes from your last TWO visits with your primary care provider are required) *
Visa
Signature of Patient *
clear
Powered byFormsite