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.

 

APPOINTMENT REQUIREMENTS:

1. After booking an Under 18 MMJ Appt, complete the online Under 18 Cannabis/CBD Intake Form 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.

QUESTIONS? CALL US AT 720-273-3568

REQUIRED DOCUMENTS

These documents may be uploaded when completing the online Intake Form, 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!

Email: frontdesk@holoshealth.org

Fax: 720-612-4271

Questions? Call us at 720-273-3568