What We Require for your Initial Appointment




Completed in-take packet that you may complete on-line. This form can also be downloaded using the buttons below or you are welcome to visit a clinic location to complete the forms, but please call first as some are open by appointment only. We can also mail you the forms if that would help!


Clear color copy of your ID, which you can email or fax to us or send to our HIPAA protected cell phone number: 318-344-4890 and please indicate which clinic is to receive the ID.


Medical Records: Confirming your debilitating medical condition. And remember it's ANY debilitating condition.

Additionally, our physicians are available for a consultation regarding your
medical condition and/or a records review prior to your initial visit to save you any
inconvenience of an appointment for a non-qualifying condition. We have also attached a consent to your physician that we can fax over if you sign and return to us if that will help you. We have found that patients usually have greater success getting their records than we do, but we are happy to help!

New Patient Fees

Initial payment of $99, this is a NON-REFUNDABLE FEE once the physician evaluates you. If you are approved, the $99 fee includes a 30-day recommendation. Recommendations are available for up to 1 year and there are several affordable payment options, please ask our staff about recommendations for up to 1 year.

Please call us if there are any questions about our fee structure at 318-227-4088. All treatment with Medicinal Marijuana will be an out of pocket expense. Insurance, Medicaid/Medicare do not cover this type of treatment at this time. If you'd like to schedule an appointment with us, you can contact our offices.

Forms