Patient First Name(Required) Patient Last Name(Required) Birth Gender(Required)MaleFemaleDate 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 doctorNew PatientFollowup PatientTransfer PatientPreferred Time of Appointment(Required)8:00am8:05am8:10am8:15am8:20am8:25am8:30am8:35am8:40am8:45am8:50am8:55am9:00am9:05am9:10am9:15am9:20am9:25am9:30am9:35am9:40am9:45am9:50am9:55am10:00am1:00pm1:05pm1:10pm1:15pm1:20pm1:25pm1:30pm1:35pm1:40pm1:45pm1:50pm1:55pm2:00pm2:05pm2:10pm2:15pm2:20pm2:25pm2:30pm2:35pm2:40pm2:45pmPreferred Date of Appointment(Required) MM slash DD slash YYYY Patient ID #(Required)From your medical marijuana card
