Card Number should follow the format below and is on your Medical Cannabis card.
MMCC ID Card Expiration Date *
MMCC ID Card Expiration Date
Name *
Name
Birth Date *
Birth Date
Address *
Address
Phone *
Phone
Provider Address
Provider Address
Condition *
Select all that apply

* As a part of your patient registration your email will be added to the PAH communications list.

 
Don’t be shy about protecting PII

At Peninsula Alternative Health we take protecting personal identifiable information very seriously.  Any information you give to us will remain confidential.

Regardless of whether you are a patient or just someone who is looking to gather more information on medical cannabis - WE WILL NOT SELL YOUR INFORMATION / DATA TO A THIRD PARTY.