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Intake Paperwork
First & Last Name
Email Address
Date of Birth
Phone Number
Mailing Address
How did you hear about us?
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If selected other,
Is this a renewal? *The OMMA will not renew MMJ cards until 30 days of expiration or less.
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Do you have Medicaid, Medicare, or Soonercare?
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Medicare
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Do you take any medications?
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Are you a Veteran?
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