Frank Wellness Patient Evaluation
Welcome to Frank Wellness. Before you meet with the doctor, we will need to gather some information regarding your medical and psychiatric health. This information will be kept confidential and stored on secure, HIPAA-compliant servers.

BEFORE YOU CONTINUE, you'll need to obtain a medical cannabis Patient ID Number from the State's website here: https://padohmmp.custhelp.com/app/adult-patient-registration. For help with this step please call 888-733-5595.

New patient evaluations are $150. My recertification evaluation fee for patient's I've seen before is $100, payable at the end of the visit.
Sign in to Google to save your progress. Learn more
Please select one: *
How did you hear about us?
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Frank Wellness. Report Abuse