Apply for your medical marijuana card Step 1 of 2 50% First Name* Last Name* Date of Birth* MM slash DD slash YYYY Phone*Email* City*Must be an Oregon resident. Is this a new card or are you renewing?*Please choose one.SelectThis is a new OMMP CardThis is a renewal from another clinicThis is a renewal from OMMC ClinicPlease check the conditions you have been formally diagnosed with Alzheimer's Disease Cachexia Chronic and/or Severe Pain Glaucoma Hydrocephalus Multiple sclerosis Muscular Dystrophy Neurodegenerative disease Post-Traumatic Stress Disorder (PTSD) Severe Nausea Traumatic Brain Injury (TBI) or Post-Concussion Syndrome Amyotrophic lateral sclerosis Cancer Epilepsy or Seizures HIV/AIDS Migraine/Severe Headaches Muscle Spasms Myasthenia Gravis Parkinson's disease Seizures (including those characteristic of Epilepsy) Spinal cord injury Any other conditions that you have been formally diagnosed with Please note- Oregon does NOT include depression, anxiety or insomnia as qualifying for a OMMP card.Is there anything else you would like our physician to know?Are you pregnant or nursing?* Yes No Are you 18 or older?* Yes No Have you been diagnosed with schizophrenia or schizotypal conditions?* Yes No Not Sure Do you have your own medical records?*Please Choose One Yes No How would you like to submit your records?* I will upload my records I would like to fax or email my records I don't currently have them with me Medical Records Upload* Drop files here or Select files Max. file size: 10 MB, Max. files: 10. Would you like help getting records from an established patient portal?*There will be the option to fill out a medical release after you click submit below. Yes, please contact me for login No, I don't have a portal Yes, I will send my records from my portal CommentsThis field is for validation purposes and should be left unchanged.
