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New Patient Intake Form

Do I need to fill out a new patient intake form?

The New Patient Intake Form is required to be completed by the patient and/or caregiver on the first visit to FiSci Dispensary. We will use this information to create an account profile within our systems to better help and guide you through your medical cannabis journey.

Once you have submitted your New Patient Intake Form, you will not need to fill out another unless you want to update information in your account profile.

*You will still need to bring valid forms of ID.*

LET US HELP

Save Time on New Patient Intake Form by Downloading & Printing, or Completing Digitally.*

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New Patient Intake Form

Complete Digitally

Follow the link to complete New Patient Intake Form on your phone or computer. Fill out your New Patient Intake Form from your phone or computer! We can send a digital New Patient Intake Form using intakeQ that you can complete electronically, sign, and return before your first dispensary visit!

Download. Print. Complete and Bring.

Follow the link to print a physical copy to bring completed on your first visit. Save time by downloading the New Patient Intake Form at home, and bringing a completed version to the dispensary on your first visit!

We also have physical copies available at Firelands Scientific Dispensary when you visit.