Patient Registration

Create your account by completing the application form below

Patient Information

For New Patients only. The personal information provided on this Registration Application must match the information that appears on the Medical Document. *Indicates required fields.

First Name*

Last Name*

Gender*

Date of Birth*

Email*

Phone*

Preferred Language*

Coverage Information (if applicable)

Are you a Veteran? If yes, provide your VAC “K” number below. By indicating your K number, you give permission to Opticann Patient Care to share your details with Veterans Affairs Canada.

If you are a C.A.R.P. Member (Canadian Association of Retired Persons), enter your Member ID # and expiry date below (i.e. CARP# 1234567 exp. DD/MM/YYYY). If you would like to become a new C.A.R.P. member through Opticann, enter “JOIN CARP” below.

Veteran's Affairs Canada K# / C.A.R.P. Member ID#

Residential Address

Street Address*

Unit/Apartment

City*

Province*

Postal Code*

Shipping Preference

Where should we ship your order to? Choose one:

Same as residential address above

Ship to a different address noted below

Ship to Health Care Practitioner's business address as per your Medical Document

*If you have requested to ship to the health care practitioner, please fill in their address as the shipping address

Shipping Address

Address Line 1*

Unit/Apartment

City*

Province*

Postal Code*

Caregiver Information

N/A

First Name

Last Name

Date of Birth

Phone Number

Referral Code

Terms & Conditions

By signing below, the applicant or person responsible for the applicant, confirms and agrees to the following:

the applicant ordinarily resides in Canada,
the information in the application is correct and complete,
the medical document that forms the basis for the application has not, to the knowledge of the individual signing the statement, been altered,
the medical document is not being used to seek or obtain cannabis products from another source,
in the case where the applicant is signing the statement, they intend to use any cannabis product that is supplied to them on the basis of the application only for their own medical purposes, and
in the case where an adult who is named under the above section "Caregiver Information" is signing the statement, they are responsible for the applicant.
The indications, safety and risks of medical cannabis use have not been adequately studied and the appropriate dosage is unclear. Patient and caregiver (if applicable) acknowledge(s) that any medical cannabis product obtained from Opticann is done so at their own risk and release(s) Opticann, along with its affiliates, partners, providers, directors, officers and employees from any and all actions, claims, complaints, and demands for damages, loss or injury whatsoever arising directly or indirectly as a consequence of the use of medical cannabis products.
Access to Cannabis for Medical Purposes Regulations (including disclosure of personal information to provincial licensing authorities upon request)” with the following text: “Cannabis Act (Canada) and the Cannabis Regulations, including disclosure of personal information to provincial licensing authorities upon request.
By signing this registration form, patient and caregiver (if applicable) allow Opticann to (a) send medical cannabis product to the physical addresses provided therein, and (b) communicate via the email address provided regarding registration status, account information, purchases, order status, product availability and other matters in accordance with it's Privacy Policy.
I consent to receiving news, updates, exclusive offers, promotions and educational information from Opticann via email. I understand I can withdraw my consent at any time by contacting Opticann Patient Care Team at 1-855-437-2266 or by unsubscribing.

By typing my name below and clicking [“Submit”], I acknowledge that I am providing my digital signature and I confirm and acknowledge the Terms & Conditions above.

Signature*(Type Your Name)

Date*

Click Submit only once. Your information will process.

Next Step: Submit Your Medical Document

To complete your patient registration, a Medical Document signed by a prescribing healthcare practitioner is required by Health Canada. Download our Medical Document form and send to your healthcare practitioner to fill out and fax to us.

Don’t have a healthcare practitioner? Book a virtual appointment with our clinic partner to consult with a knowledgable physician in under 15 minutes.

Download Registration Application

If you prefer to submit your application offline or if you are experiencing issues registerting online, please use our downloadable registration application and email your completed form to: info@opticann.ca.

For more information about the registration process and other questions about medical cannabis, please review our FAQ.

Order Products

After we receive your completed Medical Document and registration application, your account will be verified within 1-3 business days.

Once confirmed, you will receive a welcome call and email with your unique Patient ID to login and start shopping.

Contact Patient Care

If you need any assistance, we are here to support you.

For inquiries related to registration, renewing, or product information, call toll-free: 1-855-437-2266.

Our office is open Monday to Friday 8:30 AM–6:00 PM EST (except for statutory holidays when we are closed).

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