Age Gate
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WELCOME TO
RISE DISPENSARIES

It’s nothing personal,

WE GOTTA MAKE SURE YOU’RE 21+*

*For Pennsylvania, New York, Maryland and Minnesota you must be 18+

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Medical Card Assistance Request Form

I Want Assistance With:*

  1. Getting A Medical Card

  2. Renewing My Medical Card

  3. Something Else

State*

Nearest RISE Dispensary*

First Name*

Last Name*

Email*

Phone*

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

  1. Google

  2. Leafly

  3. Weedmaps

  4. Yelp

  5. Referral/Friend

  6. News Article

  7. Doctor’s Recommendation

  8. Others

Additional Notes (Optional)

0 of 500 max characters

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