Progress Note -

Skip to content

Get Started
Information

New Patient - $160

Followup - $80

Transfer - $40

Patient First Name(Required)

Patient Last Name(Required)

Birth Gender(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Street Address(Required)

City(Required)

Zip Code(Required)

Phone(Required)

Email(Required)

Type of Appointment(Required)

New Patient: has never had a medical marijuana card before. Followup Patient: current or expired medical marijuana patient whose last appointment was with Dr. Pulido Transfer Patient: current or expired medical marijuana patient who last saw a different medical marijuana doctor

Preferred Time of Appointment(Required)

Preferred Date of Appointment(Required)

MM slash DD slash YYYY

Patient ID #(Required)

From your medical marijuana card

Emed Webmail
AML Webmail
ECW
Standalone Consent Form
Standalone Progress Note

(904) 586-0041
main@affordablemarijuanalicense.com
2624 Atlantic Blvd. Jacksonville, FL 32207