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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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Alyssa
Courtney
Heather
Jennifer
Lexie
Lokal Source
Other
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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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This will be my first Medical Marijuana Card
I am within the required 30 days of expiration for my renewal.
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Do you have Medicaid, Medicare, or Soonercare?
Medicaid
Medicare
Soonercare
Doesn't apply to me
Do you take any medications?
Yes
No
Are you a Veteran?
Yes
No
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