Service Alert: Due to a potential strike, shipping via Purolator is currently unavailable.
Visit our blog for more details.
Registration Amendment Forms Banner

Registration  Amendment Form

Changing Address, Email, Phone and Fax Numbers

Use the Registration Amendment form below or send us a Registration Amendment form.

Changing Name, Gender, or Date of Birth

To change your name, gender, or date of birth please send us a Registration Amendment form accompanied with official documentation of the change. Once we verify and apply the changes, we will send you a new CanniMed Client Registration Document via mail and/or email.

Changing Caregiver

To change the person responsible for the client please send us a Registration Amendment form accompanied by a signed and dated statement from the individual responsible. Once we verify and apply the changes, we will send you a new CanniMed Client Registration Document via mail and/or email.

Updating your Health Care Practitioners Address

To update your Health Care Practitioners address please send us a Registration Amendment form accompanied by a signed and dated consent to receive product from your Health Care Practitioner. Once we verify and apply the changes, we will send you a new CanniMed Client Registration Document via mail and/or email.

Other

If there is any other account info you would like to update please send us a Registration Amendment form. Once we verify and apply the changes, we will send you a new CanniMed Client Registration Document via mail and/or email.

If you have any other questions, you can also reach us at 1-855-787-1577 or at info@cannimed.com.

Registration Amendment Form

Your browser does not support the Amendment Form. Please try another browser, download and submit the form on the right, or contact us at 1-855-787-1577 or info@cannimed.com.

Applicant Information

Client Name :    
CanniMed client number :  

Please select which situation applies to you

Declaration of the Applicant or the Person Responsible For the Applicant

  • The client is ordinarily a resident in Canada.
  • The information in the application is correct and complete.

Applicant/Person responsible for Applicant signature

Please sign in the box above. It is difficult to replicate your exact signature using a mouse or touch pad. Just try your best.