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Application Renewal Form

Applicant Information



Optional Information


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Persons Responsable

Person responsible for the Applicant

Person responsible for Applicant signature

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Person responsible for the 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.

Person responsible for the 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.

Declaration of the Applicant or the Person Responsible For the Applicant

Important, please read and sign below:

  • The applicant acknowledges that medical cannabis is not approved for the use as a drug in Canada, that its indications, safety and risks have not been adequately studied and the appropriate dosage is unclear. The applicant acknowledges and agrees that he or she is using any medical cannabis product obtained from CanniMed Ltd. at his or her own risk, and releases CanniMed Ltd. (and its production partners, including Prairie Plant Systems Inc.) 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 obtained from CanniMed Ltd.
  • The applicant is ordinarily a resident in Canada.
  • The information in the application and Medical Document or Registration Certificate is correct and complete.
  • The Medical Document or Registration Certificate is not being used to seek or obtain fresh or dried cannabis, or cannabis oil from another source.
  • The original Medical Document or copy of Registration Certificate accompanies this application or has/will be sent separately.
  • The applicant will use fresh or dried cannabis, or cannabis oil, only for their own medical purposes.
  • The applicant gives consent to CanniMed Ltd. to forward the necessary personal information to our production licensed producer, the applicant’s health care practitioner and service providers for purchasing, shipping, verification and distribution purposes only. Note: this consent is required to receive our products.
  • The applicant gives consent to his or her health care practitioner to forward the necessary personal information to CanniMed Ltd. in order to register the applicant and fulfill his or her orders.

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.