Get Your Georgia Medical Marijuana Card

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Patient Information

First Name *

Middle Name

Last Name *

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GA Driving License # *

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Diagnosis *

Date diagnosed*

How long have you been resident of the State of Georgia?*

Check if the patient will be the cardholder and is their own caregiver

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Get Your Georgia Medical Marijuana Card

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Additional Patient Information

How long has the patient been a resident of the State of Georgia?