Patient Card
Application
Apply for your patient card now!
contact details
salutation
Please Choose...
Mr.
Mrs.
Diverse
First name
Surname
Birthdate
Email address
Delivery address
First name
Surname
Street and house number (without comma)
Zip
City
Prescribing doctor
Salutation
Please Choose...
Mr.
Mrs.
Diverse
Titles
Please Choose...
Dr.
Prof.
Prof. Dr.
Andere
First name
Surname
Street, house number
Zip
City
Prescribed products
Select the products prescribed by your doctor.
Medicinal cannabis flowers
Medicinal cannabis extract
Recipe upload
Just upload your recipe here. (max. file size 5MB)
Upload file
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fileuploaded.jpg
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