Forms

Download Patient Forms

Registration Application

New patients can easily register with us online, via email or mail. The fastest way to register is to use our online application form.

If you prefer to fill out and/or print the application, please download the fillable pdf form here and email the completed registration form to: info@heritagecann.com.

To send by mail, our mailing address is:
Opticann Patient Care
333 Jarvis St.
Fort Erie, ON L2A 2S9

Medical Document

A Medical Document (similar to a prescription) is required by Health Canada to authorize patients to purchase medical cannabis and and must be signed by a healthcare professional.

Patients can download a copy of our blank Medical Document form to forward to your physician or licensed cannabis clinic to use and send to us.

The completed Medical Document must be submitted by the prescribing physician to Opticann’s secure fax line: 437-826-9005.

Upon receipt of both completed forms, our Patient Care team will verify and approve patient registration (usually within the same day or next business day).

Confirmation will be emailed to the patients’s registered email with their Client ID # to login to shop on our Patient Portal and begin ordering products.

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