Online Patient Self Referral Form

To ensure your appointment is booked and completed as soon as possible, please fill out all information. After submitting this form to Canabo Medical Clinic, one of our dedicated experts will contact you by phone or email with the details of your appointment. Your information will be kept private, secure and only accessible to our experts in order to speak with you about medical cannabis. For more details please read our privacy statement ( Our dedicated medical cannabis experts will be happy to guide you through our process and answer any questions you may have.

    Chronic PainGoutDiabetesLupusNeurodegenerative Disease (Alzheimers, Parkinsons, etc)CancerArthritisFibromyalgiaAnxietyDepressionPTSDSleep DisorderBowel DiseaseMultiple SclerosisEpilepsyOther


    Important: Please note that we will be contacting you from 1-888-282-7763. If you do not answer this call you could be delayed in receiving your appointment with our clinic. Please feel free to contact us directly at the number provided, if you do not receive a call from us within one business day of submitting your referral.

    While we are able to assist patients with "Registering to produce or possess cannabis for their own medical purposes", or obtaining a Registration Certificate to cultivate their own cannabis, Doctors in our clinic network typically require multiple in-person visits, as well as proof of a stabilized cannabinoid treatment plan on medical cannabis sourced from a Licensed Producer. As such, this form cannot be used to support these types of requests.