New York Patient Registration Form

Thank you for your interest in registering with our dispensary. Please complete the Patient Pre-Registration form below. If you have any questions, please contact us and a patient care specialist will reach out to you.

New patients: You must bring your patient certification form each time you visit the dispensary.

Download NY Patient Form

Part 1 *Personal Info

Part 2Medical Cannabis History

Part 3 *Privacy Practices Notice

Part 4 *Code Of Conduct Agreement

Part 5 *Authorization

Thank You For Being Here!
We are honored you’ve chosen RISE as your medical cannabis provider. We look forward to getting to know you. Please tell us a little about you and your history with medical cannabis.

New York Patient Registration Form

Thank You For Being Here! We are honored you’ve chosen RISE as your medical cannabis provider. We look forward to getting to know you. Please tell us a little about you and your history with medical cannabis.

Thank You For Being Here!
We are honored you’ve chosen RISE as your medical cannabis provider. We look forward to getting to know you. Please tell us a little about you and your history with medical cannabis.