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Application Process

Updated July 29, 2013

 

To schedule an appointment, please call 408.792.5065. We can not accommodate walk-ins.

Once an appointment is made, the following items must be brought to your appointment:
 

1. A completed application. Forms can be downloaded and completed prior to your visit, or filled out during your appointment.

 

MMICP English Application

 

MMICP Spanish Application

2. Government issued photo identification (i.e. California State Driver’s License, a California State ID Card, a United States Passport, a Veteran’s Administration ID Card).

3.Proof that you live in Santa Clara County, for example, the current photo IDs listed above, a recent utility bill, or a recent rental or mortgage payment receipt.

4. Written documentation completed by your physician that states that you have been diagnosed with a serious medical condition and that the medical use of marijuana is appropriate.

Physician form to document patient's medical condition for use of medical marijuana.

Verification Form English

Verification Form Spanish

5. Cash or money order payable to the Santa Clara County Public Health Department in the amount of $150. If you have proof of Medi-Cal benefits, such as a current Medi-Cal card, the fees are reduced to $75. All Fees are non-refundable.
Note: Your photo will be taken on the day you submit your application.
 
All information contained in this website is subject to change without notice.
 
Participation in the program is voluntary 
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