Squamish Contact info: p 604.892.9699 e info@99northdispensary.com

New Member Application Package

APPLICATION PACKAGE
This package contains the three essential forms to complete.
Membership Application, Practitioner Statement and the Membership Code of Conduct.

Optional forms for your health care provider

Medical Information Release Form
If needed, this form empowers your health care provider to send us your confirmation of diagnosis.

CMPA Release Form for Medical Practitioners
If needed, this form from the Canadian Medical Protective Association reduces your doctor’s liability in regards to your use of medicinal cannabis.

Other Forms

Caregiver Package
This package allows a member to assign a caregiver to assist with their needs.

Parental Consent Package

This package is for Parents or Guardians of a minor. (A completed Caregiver Package is also required for the Parent or Guardian)

Vet application package
This package contains both the Application for your Pet, and the Veterinarian Statement (your Pet’s Veterinarian must fill out this form to confirm your Pet’s diagnosis and/or recommend the use of cannabis as a medicine.) all in one package.