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(505) 299-7873
5401 LOMAS BLVD NE, ALBUQUERQUE, NM 87110
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Medical Cannabis Program
Schedule Appointment
Pain Specialist
Schedule Appointment for Pain Specialist Marijuana Doctor
First Name
Middle Name
Last Name
Date of Birth
If you are under 18 years of age you must have your parent fill out the form under their name
Email
Receive email updates
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Medical Condition
Amyotrophic Lateral Sclerosis (ALS)
Cancer
Crohn’s Disease
Epilepsy
Glaucoma
Hepatitis C Infection currently receiving antiviral treatment (proof of current anti-viral treatment required)
HIV/AIDS
Huntington’s Disease
Hospice Care
Inclusion Body Myositis
Inflammatory autoimmune-mediated arthritis
Multiple Sclerosis
Damage to the nervous tissue of the spinal cord, with (proof of objective neurological indication of intractable spasticity required)
Painful Peripheral Neuropathy
Parkinson’s disease
Post-Traumatic Stress Disorder
Severe Chronic Pain
Severe Anorexia/Cachexia
Spasmodic Torticollis (Cervical Dystonia)
Ulcerative Colitis
If more than one medical condition applies then select the medical condition that you are most interested in receiving cannabis treatment for. Additonal medical conditions may be added at a later time.
If cancer, please specify type
Physical Address
You must have a New Mexico address to enroll in the Medical Cannabis Program
Street Address 1
Street Address 2
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You must have a New Mexico address
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Contact Info
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Check the box above if you would like to receive text message updates to your phone about coupons and specials from dispensaries
Questionnaire
Do you plan on growing your own cannabis?
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