New Patient Certification + High Dose (16oz) Certification

Legal First Name

Legal Last Name

Telephone Number

Email Address for State Registration

Password for State Login - COMPLIA - MMMP - State Login Password (The password to view your medical card)

SSN

Date Of Birth

Address

Please provide a detailed description of your qualifying condition - This will be reviewed by a physician for qualification.

State Issued ID

Front Facing Photo (A selfie showing your shoulders and above)

After you click submit, your card will be charged for $200. Your receipt will be emailed to the email above and you will be contacted by a Bluebird Wellness Center specialist to complete your registration.

I agree to the Terms & Conditions