Get Your Medical Marijuana Card in Jacksonville, FL

M-Th: 8:30-11AM 12:30PM-3:30PM Fri: 8:30-11:30am Sat: 8AM-12PM(Closed first Friday and open only first Saturday of the month)PLEASE TEXT US AT 904-586-0041main@affordablemarijuanalicense.com2624 Atlantic Blvd Suite #5Jacksonville, FL 32207

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GET YOUR MEDICAL MARIJUANA CARD IN JACKSONVILLE

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Medical Marijuana Application

Complete this form to find out if you qualify for a medical marijuana card in Jacksonville today!

What Type of Appointment Do You Need?(Required)

Are you at AML right now?(Required)

No, this is an online request

Yes. Select this option ONLY if you are present in person at the office and will be paying for your appt right now.

Patient First Name(Required)

Patient Last Name(Required)

Preferred Name

Date of Birth(Required)

Month

Day

Year

Preferred Gender

Gender on Driver's License(Required)

Male

Female

Street Address(Required)

City(Required)

Zip Code(Required)

Phone(Required)

Email(Required)

Please list your current medications(Required)

Are you pregnant or breast-feeding?(Required)

Yes

We cannot see patients that are pregnant or beast-feeding. If you have questions please call our office at 904-586-0041. Thank you for understanding.

Please select at least 3 qualifying medical conditions you have(Required)

ADHD

AIDS

ALS

Alopecia Areata

Alzheimer’s

Ankylosing Spondylitis

Anorexia

Anxiety

Arthritis

Asthma

Autism

Autoimmune Hemolytic Anemia

Balance Disorder

Bipolar Disorder

Bone Pain

Brain Trauma

Camptocormia

Cancer

Chronic Abdominal

Chronic Fatigue Syndrome

Chronic Nausea

Chronic Pain

Chronic Vomiting

Crohn’s

Degenerative Disc Disease

Depression

Diabetes

Diabetic Pain Neuropathy

Diabetic Retinopathy

Diverticulitis

Dysphagia

Dystonia

Ehler-Danios Syndrome

Epilepsy

Fibromyalgia

Glaucoma

Gout

Grave’s Disease

Gullain-Barre Syndrome

HIV

Hashimoto’s Thyroiditis

Headaches (Chronic)

Hemiplegia

Huntington’s Disease

Hydrocephalus

Idiopathic Thrombocytopenic Purpura

Inflammatory Bowel Disease

Insomnia

Irritable Bowel Syndrome

Juvenile Rheumatoid Arthritis

Low Back Pain

Lupus

Meralgia Paresthesia

Migraines

Multiple Sclerosis

Muscle Spasms

Muscular Dystrophy

Musculoskeletal Pain

Myasthenia Gravis

Neuromyelitis Optica

Neuropathic Pain

OCD

Obstructive Pulmonary Disease

Osteoarthritis

Osteoporosis

PANS/PANDAS

PTSD

Pancreatitis

Panic Attacks

Parkinson’s

Pelvic Pain

Peripheral Artery Disease

Polyarteritis Nodosa

Post-Polio Syndrome

Psoriasis

Rheumatoid Arthritis

Scoliosis

Sjogren’s Syndrome

Social Anxiety

Spinal Stenosis

Tardive Dyskinesia

Terminal Conditions

Tics

Tietze Syndrome

Tourette’s Dermatologic Conditions

Ulcerative Colitis

Vitiligo

Do you have any other medical conditions?

Are you allergic to any medications?(Required)

Yes

Please list the medications you are allergic to(Required)

Have you been hospitalized?(Required)

Yes

Please list and describe your hospitalizations with dates.(Required)

Have you had any surgeries?(Required)

Yes

Please list and describe your surgeries with dates.(Required)

Family History – Father(Required)

Alive

Deceased

Unknown

Father Cause of Death(Required)

Cancer

Hypertension

Diabetes

Natural Causes

Family History – Mother(Required)

Alive

Deceased

Unknown

Mother Cause of Death(Required)

Cancer

Hypertension

Diabetes

Natural Causes

Do you smoke cigarettes?(Required)

Yes

Do you drink alcohol?(Required)

Yes

Are you using illicit drugs?(Required)

Yes

Are you pregnant/breastfeeding or planning pregnancy within the next year?(Required)

Yes

Do you have any family history of addiction?(Required)

Yes

Please choose the day of the week you'd like your appointment(Required)

Monday-Thursday

Friday

Saturday

M-Th Date(Required)

MM slash DD slash YYYY

Please Choose the Time Of Your Appointment(Required)

Fri Date(Required)

MM slash DD slash YYYY

Please Choose the Time Of Your Appointment(Required)

Sat Date(Required)

MM slash DD slash YYYY

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.

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

More Information Here FL State Exception Explanation & Application Form

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)

You must update your Florida Driver's license to the current information before your appointment. The Florida Medical Marijuana Use Registry (MMUR) is connected to Florida's Department of Highway Safety and Motor Vehicles and will pull your info from their database. If it is not correct you will not receive your medical marijuana hard copy license. You cannot make these changes after we have submitted your application to the state. Therefore, you cannot be seen unless your license is up to date.(Required)

I understand.

If you do not have a Florida ID or Driver's License.(Required)

The Florida MMUR connects to the OMV to access patients’ State ID photo and to verify their address. If a
patient does not have a Florida license, they must provide the following directly through the registry.
• A Photo – The photo must be passport style and can be purchased at UPS, Walgreens, CVS and
other professional photo studios. Please ask for a digital picture so that you may upload it to the
MMUR. Do not upload a photo of a picture.
• Proof of Residence – You must provide at least TWO of the following:
o Deed/Mortgage/Lease Agreement.
o Work order or utility hookup dating back 60 days from application.
o 60-days old utility bill. Phone or cable bill will not suffice.
o 60-days old mail from a financial institution.
o 60-days old mail from federal, state, county, or municipal government.
o A statement or letter from someone who resides with patient with one proof that this person
is a resident.

I understand

Anything else we should know?

Disclaimer: Your confirmed appointment will be the nearest available appointment on our schedule at the time of your request. If you find a more convenient time you can contact our office directly to reschedule.

Disclaimer: You certify that the information provided is correct to the best of your knowledge and understand that to falsify information is grounds for denial of certification. Completing this form in no way constitutes approval of a medical marijuana certification. You further acknowledge acceptance of a solicitation from Affordable Marijuana License in regards to medical marijuana.

What You Need

– a valid Florida Driver’s license or State ID (up-to-date with the correct information, including address)
– your Medical Records, if available

Questions?

Check our FAQ

Frequently Asked Questions

What’s Next?

After you complete the form on this page, a patient care specialist will confirm your appointment with one of our qualifying physicians. If our physician determines you qualify, they will enter you into the Medical Marijuana Use Registry, so the Florida Department of Health can issue you a certification. Once you receive your state-issued certification, you are free to visit a local dispensary. Still have questions? Give us a call at (904) 586-0041.

QUESTIONS OR COMMENTS?

Questions about medical marijuana? Contact a certified marijuana doctor today!

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