BudTender — New Patient Registration

Personal Information

Tell us a little about yourself

First Name *

Last Name *

Phone Number *

Email Address *

Date of Birth *

Home Address

Where should we reach you?

Street Address *

Apt / Suite / Unit (optional)

City *

State *

ZIP Code *

Patient Type

How will you be using cannabis?

Select the option that best describes your situation. Medical patients will need to provide their medical marijuana card information.

🏥

Medical

I have a medical card or prescription and am using cannabis for health conditions

🌿

Recreational

I am of legal age and using cannabis for personal enjoyment and wellness

Cannabis Background

Help us understand your experience and preferences

Experience Level *

How familiar are you with cannabis products?

🌱

No Experience

Never used cannabis before

🌿

Beginner

Used a few times, still learning

🍃

Intermediate

Regular use, comfortable with basics

🌳

Advanced

Very experienced, knowledgeable user

Preferred Relief Time *

When do you primarily seek relief?

📅All Day

🌅Morning

☀️During Day

🌙Night

Preferred Method of Consumption *

Select all that interest you — we'll tailor product recommendations to your preferences.

🍬Edible

🚬Smoking

💨Vape

💧Tincture

🧴Topical

🔬Concentrate

✨No Preference

Health Background

Helps us recommend safe, compatible products

This information is kept completely private and is only used to ensure product compatibility and safety.

Known Allergies List any allergies that could affect product recommendations

Current Medications Cannabis can interact with some medications — this helps our staff guide you safely

Conditions & Symptoms

Select all that apply so we can find the best products for you

Conditions *

Select any conditions you are managing or seeking relief from.

Add a custom condition

Symptoms *

Select the symptoms you are most looking to address.

Add a custom symptom

Overall Symptom Severity *

Rate the overall severity of your symptoms on a scale of 1 (mild) to 10 (severe).

1 — Mild 5 10 — Severe

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Additional Notes This helps our team provide the most personalized recommendations