Renew Please complete this short form so we can assist you in renewing your Michigan medical marijuana card. Choose All Medical Conditions That Apply to YouGeneral Conditions Severe Pain Nausea Muscle Spasms Seizures Cancer Specific Conditions Cachexia Glaucoma HIV+/AIDS Agitation of Alzheimer's Crohn's Disease Hepatitis C Nail Patella ALS None I suffer from NONE of the above conditions You have indicated that none of the above conditions apply. However, this may not be true. Take a look through the detailed conditions below and make sure that none apply to you. Don't be afraid to check the "OTHER" box if you are just not sure. You have indicated that you are suffering from "Severe Pain". Please help us narrow down your condition by choosing a more specific item below. Don't be afraid to check the "OTHER" box if you are just not sure.Severe Pain Arthritis Chronic Pain Syndrome Colitis – Ulcerative Chronic Back Pain Degenerative Joint Disease (DJD) Degenerative Disc Disease (DDD) Fibromyalgia Gout GERD (Reflux) Herniated Disc Irritable Bowel Syndrome (IBS) Lumbar Stenosis Lumbago Lupus w/ Joint Involvement Migraine Headaches Neuropathy Plantar Fasciitits Ruptured Disc Radiculopathy Spinal Stenosis Spondylosis Spina Bifida Scoliosis Severe Peptic Ulcers Severe Joint Pain TMJ Trigeminal Neuralgia Chronic Fatigue Syndrome (CFS) OTHER Severe Pain Condition Other Please Describe Your Exact Severe Pain Condition*You have indicated that you are suffering from "Nausea". Please help us narrow down your condition by choosing a more specific item below. Don't be afraid to check the "OTHER" box if you are just not sure.Nausea Chemotherapy Diverticulosis Irritable Bowel Syndrome (IBS) Medical Associated Nausea Meiner's Disease Nephropathy Peptic Ulcers Radiation Therapy Sprue Vertigo Chronic Fatigue Syndrome (CFS) OTHER Nausea Condition Other Please Describe Your Exact Nausea Condition*You have indicated that you are suffering from "Muscle Spasms". Please help us narrow down your condition by choosing a more specific item below. Don't be afraid to check the "OTHER" box if you are just not sure.Muscle Spasms Chronic Back Pain Charcot-Marie-Tooth Disease Limb Trauma Movement Disorder Nocturnal Leg Cramps Parkinson’s Disease Restless Leg Syndrome Tourette’s syndrome Spasticity Condition Multiple Sclerosis OTHER Muscle Spasm Condition Other Please Describe Your Exact Muscle Spasm Condition*You have indicated that you are suffering from "Seizures". Please help us narrow down your condition by choosing a more specific item below. Don't be afraid to check the "OTHER" box if you are just not sure.Seizures Epilepsy OTHER Seizure Condition Other Please Describe Your Exact Seizure Condition*You have indicated that you are suffering from "Cancer". Please help us narrow down your condition by choosing a more specific item below.Cancer Bladder Breast Colon Rectal Endometrial Kidney Leukemia Lung Melanoma Non-Hodgkin Lymphoma Pancreatic Prostate Thyroid OTHER Type of Cancer Other Please Describe Your Exact Cancer Condition*Which location is most convenient for you?*DetroitDetroit MetroOmerSaginawOtherOther Locations*If you would like a more prompt appointment, please choose one of our locations above. If you choose one of the locations below, we will send you a list of the clinics in your area.AdrianAnn ArborBaldwinBattle CreekCadillacClareColdwaterDowagiacFlintGaylordGladwinGrand RapidsGreenvilleHollandHoughtonHoughton LakeJacksonKalamazooLansingMarquetteMioMonroeMt PleasantMuskegonOscodaPetoskyPort HuronSault Sainte MarieSouth HavenThree RiversTraverse CityThe State of Michigan requires that the doctor who signs your medical card recommendation has reviewed your past medical historyAre you currently in possession of your medical records*YesNoGreat! This will greatly speed up the process.Do you need help obtaining them?*YesNoWe can make the process quick and simple. All right. As a reminder, choosing no means you will need to contact your doctor(s) directly to retrieve your past medical history. In most cases you will need to visit the office in order to sign for the release of your records, you may need to return again to pick the documents up, unless the office is willing to mail them to you. In addition, most offices charge patients as much as $1.50 per page in order to prepare and print medical records, this fee can add up quickly. Name* First Last Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Enter Email Confirm Email Zip Code*Phone*Would you like to recieve a call?*If you are ready, we would be happy to speak with you and guide you through the process of getting your card.Yes, I am ready to schedule an appointment and can make the $25 dollar appointment depositNo, thank youWhen is the best time to reach you?*You will receive a call and if you cannot answer, a voicemail message will be left instead.Please contact me ASAP!11a - 1p1p - 3p3p - 5p5p - 7p7p+I am interested in more information about... 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