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WELCOME TO
RISE DISPENSARIES

It’s nothing personal,

WE GOTTA MAKE SURE YOU’RE 21+

Or, a qualifying patient 18+

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Day

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Are You A Registered Patient With The Commonwealth Of Virginia?*

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  2. No

Are You A Veteran?*

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  2. No

How Did You Find Us? (Check All That Apply)*

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NEW PATIENT REGISTRATION

Nearest RISE Dispensary*

Name*

Email*

Date Of Birth

Phone*

Address*

Patient ID No./Medical Marijuana Card No.*

Expiration Date*

Additional Notes (Optional)

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Would You Like A Free Consultation With Our Patient Care Team?*

  1. Yes

  2. No

Do We Have Your Permission To Send Text Message Alerts?*

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  2. No

Packaging Preference*

  1. Child Resistant

  2. Easy Open

  3. No Preference

Please upload copies of the following:

Virginia ID

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Registration Card

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Letter Of Certification

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