Become a Registered Patient
Let us guide you, learn the steps to becoming a registered patient
Patient Intake Form
Are you a first time patient? Fill out this form for quick registry.
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How to Become Registered
- Visit an Ohio Certified to Recommend physician. You must have one of the approved qualifying conditions.
- Once you have received your recommendation, your physician will enter you into the Patient and Caregiver Registry.
- You will receive an email to confirm your registry. Click on the link in the email. This will allow you access to the registry to confirm your information.
- You will then pay, using your credit card.
- Download your card. You can print a copy or show your electronic version on your cell phone when you visit us.
- You will need to show your registry card and an unexpired government issued ID.
Valid forms of ID
Accepted forms of identification include any of the following:
- Unexpired Ohio driver’s license.
- Unexpired Ohio identification card issued by the Ohio bureau of motor vehicles.
- Unexpired US passport or passport card.
- If the patient is a minor, their caregiver must also register in the Patient/Caregiver Registry.
Qualifying Conditions
- AIDS
- Amyotrophic Lateral Sclerosis
- Alzheimer’s
- Cancer
- Chronic traumatic encephalitis
- Crohn’s Disease
- Epilepsy or other seizure disorder
- Fibromyalgia
- Glaucoma
- Hepatitis C
- HIV
- Inflammatory bowel disease
- Multiple Sclerosis
- Pain
- Parkinson’s Disease
- Post-traumatic Stress Disorder
- Sickle Cell Anemia
- Spinal cord injury
- Tourette’s Syndrome
- Traumatic Brain Injury
- Ulcerative Colitis