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In order to complete the registration with Acreagepharms, the applicant (patient) or the caregiver, as applicable, will ensure the applicant’s doctor submits an original medical document via secure fax.

The information contained in the registration document is correct and complete.

The applicant ordinarily resides in Canada.

Any cannabis product supply to the applicant (patient) on the basis of this application will be used only for his/her own medical purposes.

The medical document that forms the basis for the application is not being used to seek or obtain medical cannabis from another source.

The medical document that forms the basis for the application has not, to the knowledge of the individual signing the statement, been altered.

I consent to the Health Care Practitioner named in the Medical Document disclosing personal health information to Acreagepharms for the purposes of complying with Health Canada Legislation, the requirements of the Cannabis Regulations under the Cannabis Act, and any other applicable legislation.

I understand and agree that Acreagepharms may collect, use and disclose my personal information in the manner described in its Privacy Policy. This includes sharing my information on a confidential basis with service providers only as required for the provision of the service.

Optional: I consent to receiving Acreagepharms news, updates and promotions via the contact information provided in this registration I understand I can withdraw my consent at any time by contacting OGI Client Care at 1-888-386-0149. PO Box 51, Peers, AB. T0E 1W0.

I consent to my personal health information (e.g. a copy of this document) being provided to the Health Care Practitioner named in the Medical Document.

I consent to the transfer of personal information to third-party US-based services only as required for provision of services, such as to provide patient e-mails (Sendgrid) and shipping labels (EasyPost). Please visit the linked pages directly for more information.

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