Become a Patient on the National Cannabis Patients Wall

A "Patient" for this purpose is any person, of any age, from any state that has a medical condition that is being or could be helped by the use of Cannabis therapies. The National Cannabis Patients Walls will be built for each of the United States to be displayed in that states capital in 2015 and brought together in Washington to build a Wall Against Prohibition and to bring attention to and spread awareness of the need for federal legislation that is fair and equal for all Americans.

Patients already listed on the Wall that have not filled out this digital form please continue, only fill this form once for each patient. Questions marked by an asterisk are mandatory to be represented on the National Cannabis Patients Wall Displays for any state all other information is optional but will only be used to represent patients and their needs and by giving us the tools we need to validate patient needs as we fight for federal legalization.

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    Name as you want it written or is already written on the wall.

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    Following Questions Pertain to the Use of Medical Cannabis Therapies

    If you are not able help with this section, you can submit your form now and thank you for your application. If you can help with this section we will use this information to help new patients with questions about using cannabis therapies.
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