UNDER 18 INTAKE FORM & REQUIREMENTS
We have had the distinct privilege of working with children diagnosed with serious chronic conditions like cancer, autism, and seizure disorders, and have seen remarkable transformations with cannabinoid medicine. Our doctors will work with you to develop a comprehensive Integrative and Cannabis/CBD treatment regimen for your child, and will make sure you have legal state access to their medicine.
*Please note that in Colorado, in order for a minor child to legally use any form of CBD (whether over-the-counter or from a dispensary) and/or cannabis, they must have a medical cannabis card. Additionally, an under 18 patient must receive two Physician Certifications from medical cannabis doctors, which will be electronically submitted to the State of CO MMJ Registry by our office after your appt so you can complete the Online State of CO MMJ Registry Application after your appt with us.
UNDER 18 REQUIREMENTS
Please read through the list below in its entirety to ensure that you will be fully prepared for your upcoming appointment. Your successful preparation enables our office to fully assist you in applying for your child's medical marijuana license through the State of Colorado MMJ Registry.
1. After booking an Under 18 MMJ Appt, complete the Under 18 Cannabis/CBD Intake Form (below) and upload, email, or fax ALL the required documents listed below.
*If your child is a returning patient with us, please call us so we can verify if we need updated medical records.
2. New patients must also complete the HIPAA/Policies Form (below).
QUESTIONS? CALL US AT 720-273-3568
These documents may be uploaded when completing the Intake Form (below), or can be emailed or faxed to our office. Our email and fax number are listed below.
1. Copies of both parents IDs. At least one parent must be a Colorado resident with a current CO ID or CO Driver's License.
***If a secondary parent is not involved, you will also need to provide at least one of these specific documents:
Copy of secondary parents out of state ID if parent lives out of state.
Certified copy of secondary parents death certificate if parent is deceased.
Copy of court issued sole custody order if secondary parent does not have any custody.
Copy of custody documents if you are not the parent but have legal guardianship.
2. Certified Copy of the Birth Certificate for your child.
3. Medical Records from a Primary Care Physician or Specialist stating your child has a state recognized qualifying condition. The state qualifying conditions are: CANCER, GLAUCOMA, HIV/AIDS, CACHEXIA, SEVERE NAUSEA, SEVERE PAIN, MUSCLE SPASMS, PTSD, SEIZURES, AUTISM, or OPIOID REPLACEMENT THERAPY.
4. Notarized Minor Patient Consent Form. Click here to download.
*If one parent lives out of state, they do not need to sign the consent form. If both parents live in-state, both parents need to sign the consent form in front of a notary. You may download the form here, or download the form attachment from your emailed appointment confirmation.
Please send ALL of the above documents to our office as soon as possible via intake form (below), email or fax. This ensures that our doctors can be fully prepared for your appointment. Thank you!
Questions? Call us at 720-273-3568
HOLOS HEALTH POLICIES
By scheduling an appointment, you are hereby agreeing to our Terms of Service, and the State of Colorado's Medical Marijuana Terms of Service.
By providing your email address to Holos Health you are consenting to receive email reminders of appointments and newsletters or occasional updates. You may receive a reminder phone call, email, or text from our office the day before a scheduled appointment.
Non-Acute Care Office
Holos Health does not provide acute care. Phone calls will be accepted only during office hours Monday through Friday from 9am to 5pm (no weekends or after hour calls accepted). If you have an emergency, please contact your closest urgent care center or emergency department. We do not provide prescriptions for narcotics.
Extended Plant Counts
Extended plant counts (over 6) can only be recommended for patients over the age of 30 with a debilitating, chronic medical condition. Rare exceptions are made for patients under 30. Patients under 30 who are requesting an increased plant count are required to provide medical records of the chronic medical condition. There is an additional fee for extended plant counts. Anything above 12 plants is an additional $100.
All Services and Sales are Final
All service sales are final, and refunds are not permitted. Our staff is here to assist you with the state registration process within our means. The online registration process is the responsibility of the patient. Our office does not have the ability to change the information input into a patient account once it has been submitted. You must contact the state directly regarding an issue with the online registration.
Cancellation / No Show Policy
I understand that Holos Health requires a 24-hour cancellation notice for any appointment. Failure to do so interferes with our ability to serve our patients who are in need in a timely manner. I understand that my failure to furnish 24 hours notice will result in a charge of 50% of my appointment cost.