Transcription of Instructions and Application For Initial Registration As A
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Instructions and Application For Initial Registration As A
Rhode IslandCenter for Professional LicensingRoom 105A - 3 Capitol Hill Providence, RI 02908-5097 Instructions and Application For Initial Registration As APhone: (401) 222-3752 Fax: (401) 222-1745 TTY/TDD: (800) 745-5555 Applicant - Print Name (First/MI/Last) medical Marijuana Patient**FOR OFFICE USE ONLY** Approved By:Date of Approval: Registration Number: Revised 09/14/2021 jcpDO NOT REMOVE PAGES FROM THE APPLICATIONPLEASE SEND ALL PAGES OF THIS Application WITH PAYMENTIn order to ensure timely delivery and avoid unexpected delays, please send your ORIGINAL completed Application by regular US mail.
or effects of this patient’s condition. Further, it is my professional opinion that the potential benefits of the medical use of marijuana would likely outweigh the health risks for this patient. Practitioner’s Signature: Date of Signature: This form is …
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