Patient Registration

Create your account by completing the application form below

Patient Information

*Indicates required fields. The personal information provided on this Registration Form must match the information that appears on the Medical Document. For anyone completing this Registration Form on behalf of the Applicant, please complete the required section under Caregiver Information.

Coverage Information (if applicable)

Are you a Veteran? If yes, provide your K number below including the K. By indicating your K number, you give permission to Heritage Patient Care to share you details with Veteran's Affairs Canada.

If you are an existing C.A.R.P (Canadian Association of Retired Persons) member, enter your Membership # and expiry date DD/MM/YYYY. If you would like to become a new C.A.R.P. member, enter "SIGN UP FOR CARP" below.

Residential Address

Shipping Preference

Where should we ship your order to? Choose one:

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

Shipping Address

N/A

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 Heritage is done so at their own risk and release(s) Heritage, 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 by Heritage 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 by Heritage via email. I understand I can withdraw my consent at any time by contacting Heritage 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.

(Type Your Name)

Click Submit only once. Your information will process.

Opticann by Heritage Cannabis logo

Next Step: Submit Medical Document

To complete your registration, we require a Medical Document (similar to a prescription) signed by a healthcare practitioner to authorize you to purchase cannabis for medical purposes. Your healthcare practitioner must submit your signed Medical Document to Opticann via secure fax to: (437) 826-9005.

Don’t have a healthcare practitioner? Book a FREE telehealth appointment with our trusted partner clinic, ReLeave Therapeutics, who offer virtual clinic consultations with knowledgeable physicians in less than 15 minutes.

Download Registration Form

If your prescription has expired (renewing patients), or you are experiencing issues submitting your online registration, please use our PDF registration form which can be printed or filled out. Send your completed form via email to Patient Care at: info@heritagecann.com or mail to the address indicated at the top of the form.

Once we have received your registration application, you will receive a welcome call and/or email.

Need Support? Contact Patient Care

If you need any assistance, we are here to help! For inquiries related to registering, transferring from another LP, or product inquiries, please call us toll-free at: 1-855-437-2266. Our office hours are Monday to Friday 8:30 AM–6:00 PM EST (except for statutory holidays when we are closed). You may also send us a message at anytime.