"*" indicates required fields
Please ensure you have:
When you have satisfied the above criteria, feel free to try again.
If you would like to discuss, speak to your personal doctor or contact us on 1300 122 662.
*Conventional – prescribed by a doctor and dispensed by a pharmacist – not over the counter.
You have passed the basic criteria required to be eligible for a medicinal cannabis script.
Step 2 - Fill in your contact details which only takes a few minutes.
Step 3 - One of our Patient Access Coordinators will call you within 48hrs to confirm your details, answer any questions and help you book an appointment with a doctor.
IF YOU HAVE ANY DIFFICULTIES FILLING OUT THIS FORM OR HAVE ANY QUESTIONS, PLEASE CALL US ON 1300 122 662.
New Patient Form
