dr pulido progress note + consent form - Affordable Marijuana License

Patients Seen M-Th: 8:30am-11:15 12:45-3:30pm Sat: 8:30AM-11:15am(Closed Fridays and open only 1st & 2nd Saturday of the month)CALL/TEXT 904-586-0041 Email Us 2624 Atlantic Blvd Suite #5Jacksonville, FL 32207

What Type of Appointment Do You Need?(Required)

Patient First Name(Required)

Patient Last Name(Required)

Preferred Name

Date of Birth(Required)

Preferred Gender

Gender on Driver's License(Required)

Male

Female

Street Address(Required)

City(Required)

Zip Code(Required)

Phone(Required)

Email(Required)

Would you like a Monday-Thursday or Saturday Appointment?(Required)

Monday-Thursday

Saturday

M-Th Date(Required)

Please Choose the Time Of Your Appointment(Required)

Please Choose the Time Of Your Appointment MON AUG BLACKOUT(Required)

Please Choose the Time Of Your Appointment TUES(Required)

Please Choose the Time Of Your Appointment TUES AUG BLACKOUT(Required)

Please Choose the Time Of Your Appointment WED(Required)

Please Choose the Time Of Your Appointment WED AUG BLACKOUT(Required)

Please Choose the Time Of Your Appointment(Required)

Sat Date(Required)

Please Choose the Time Of Your Appointment(Required)

Disclaimer about exemptions(Required)

Have you previously had an exemption? Please understand that per State requirements, exemptions expire and must be renewed in a separate process from your regular renewal appointments if you wish to keep them.

More Information Here FL State Exception Explanation & Application Form

Please be aware you will need to do an exemption request and renew it to keep the higher limit.
If you previously had an exemption & wish to keep it you will need to renew it. This is separate from renewing your medical marijuana card / orders. You can go ahead and submit a request now along with your application to avoid any delays. You can submit an exemption request here:

Exemption Requests

exemptions(Required)

I understand how exemptions work

Due to recent changes with the Florida MMU, it is now ONLY possible to move mgs (types of product available for purchase) within the first 70-day cycle of a patients 7-month orders. Changes after that 70 day cycle will require an exemption request, which is up to the State to approve or deny based on the patient's history.(Required)

I have read and understand this limitation.

Are you running out of any of your routes?(Required)