INSTRUCTIONS

Please click the pdf icon below to download the appropriate intake form. In order for our doctors to best be able to assist you, we ask that you submit via email or fax at least 24 hours prior to your appointment.

Required Documents for All Medical Cannabis Appointments:

  • A high quality picture of the front of your Colorado Drivers License or Colorado State ID  (as we must upload this to the State of Colorado MMJ Registry).

  • If you are under 21, you must email or fax us medical records from your doctor or specialist who diagnosed you with a state qualifying medical condition in order to be eligible to receive a medical card from the State of Colorado. 

 

Email: FrontDesk@HolosHealth.org 

Fax: 720-612-4271

Required documents for your visit: Intake Form, CO Driver's License or CO ID, and Medical Records if under 21.

After downloading this form, if you prefer to fill it out online you may need to download a free version of Adobe Acrobat Reader:  https://get.adobe.com/reader/

After saving your completed form, please email or fax it to us with your required documents. 

MEDICAL CANNABIS EVALUATION (NEW & RENEWAL PATIENTS)

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