Medical Cannabis Registration Consultation

LHHP now offers consultations for medical cannabis patient registration and renewal! Consultations are fifteen minutes long and are held via online video call. To begin the scheduling process, please fill out the online form below.

Last Name, First Name

Email Address

Date of Birth

Phone Number

Mailing Address

City

State

Zip Code

Driver's License or ID Number

What is the purpose of your medical cannabis consultation?

Have you had a medical cannabis card anywhere before?

Have you had experience with cannabis any time in the past?

If "Yes" to the above question, please give details

Have you experienced cannabis in the last three months?

If "Yes" to the above question, please give details

Have you ever had any negative side effects after using cannabis?

If "Yes" to the above question, please give details

What are the medical conditions for which you are seeking treatment with medical cannabis?

Any current medications (inc. dosages)

Any allergies

Please check any current symptoms you are experiencing:

Cough Headache Fever Heart palpitations Anxiety Nausea Stomachache Digestive problems Movement restrictions Balance problems Numbness or tingling of arms, legs, feet, or hands Any pain anywhere Difficulty urinating

If you are experiencing any other possibly negative symptoms, please describe them below:

Do you have a primary care/medical provider other than Dr. Stewart? If yes, please provide their name and contact information. If not, simply type in "Dr. Stewart"

Does your current clinician agree with your plan for including medical cannabis into your care? (If Dr. Stewart is your current clinician, simply type in "Dr. Stewart")

Past medical history - all prior diagnoses or conditions

Past surgical history - include dates

Do you currently use tobacco?

Do you have a history of drug or alcohol abuse?

I SWEAR/ATTEST/AFFIRM I have provided complete and accurate information to the best of my ability (please type your full name)

Next, download and fill out this consent form. Once you have filled it out and finished scheduling your appointment, please upload and email the completed form along with a photo of your driver’s license (or other adequate identification) to info@loudounholistic.com.

consent-form Download

Now you can schedule your video call consultation below.

Finally, pay for your appointment below (for first-time registration select “Certification Registration” and for certification renewal select “Certification Renewal”):

Certification Registration

Certification Renewal

Once you have finished scheduling your appointment and submitting your forms, you are all set! After your online video call, Dr. Stewart will fill out your medical cannabis certification (if deemed necessary).

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