Name Description
Caregiver Application This form is used to apply for an Arkansas Medical Marijuana Caregiver card. (Revised 2017-10-24) Download
Information Change Request This form is used by Qualified Patients and Caregivers who need to update information, request to add or remove a caregiver or cancel their registry ID card. (updated 12/10/2018) Download
Patient Application This form is used by an individual applying to be a qualifying patient. Revised (2017-09-18) Download
Physician Written Certification The Physician Written Certification form is to be filed out by a Physician to certify a qualifying medical condition. This form must be submitted online, or mailed to the Arkansas Department of Health, along with a completed and paid application within 30 days of physician's signature. (Revised 2019-05-30) Download
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