Request an Appointment

To request an appointment, fill out the form below OR call our business office at 855-420-8100 (toll free) Monday - Friday between 8:30am - 4:30pm.

Appointment Request Form

(data fields with an asterisk * are required)

New to Marijuana program
Renewal patient new to our clinic
Renewal patient who has seen us before
Annual office visit

Which of our clinics are you interested in visiting?

Kalamazoo
Grand Rapids
Battle Creek


Personal Information

Name:
*

E-mail:
*

Confirm E-mail:
*

Daytime Phone:



What is your MMMP qualifying condition?



Question or comments



Enter the code as it is shown (required):

I have read the Patient Privacy Notice *