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?

Grand Rapids
Battle Creek

Personal Information



Confirm E-mail:

Daytime Phone:

What is your MMMP qualifying condition?

Question or comments

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I have read the Patient Privacy Notice *