PATIENT PRE-APPOINTMENT FORM. Honolulu Wellness Center ~ Cannabis Care Clinic
Hawaii's Medical Marijuana ~ Cannabis 329 Registration Card
Visit www.HonoluluWellnessCenter.com for more information.


Three (3) easy steps:.

Step 1: Fill in this form. And we will reply by call, text, and/or email to answer any questions and set an appointment.

Step 2: Come to your appointment, (We process all the state forms for you.) and

Step 3: Receive your card in the mail from the Department of Health.

Kamaaina Special! $188 New-Patient or $138.00 renewal from anywhere: Full-Service Package! (Medical Marijuana Medical Cannabis Card Doctor Clinic) plus the $38.50 State of Hawaii Department of Health Medical Cannabis Program 329 Registration Card/Marijuana License, recommendation.
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
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DD
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YYYY
Cell Phone (We will call you back ASAP) *
Your answer
Email Address *
Your answer
Which is/are your primary Eligible Debilitating Medical Condition(s)? *
Required
I understand that I will bring any related medical records to my appointment? *
Required
Have you had a Hawaii medical cannabis program card in the past? *
How did you hear about us or note:
Your answer
Medical Marijuana Card Processing with Aloha.
Form Click Agreement:
Ohana Kamaaina Special includes medical records analysis, face-to-face appointment, one-on-one time with our in-house Certified Medical Cannabis Consultant, file creation, application processing, two additional tele-med appointments, and education. $188 Ohana Kamaaina Special ~ Full-Service Package. (Discounted $200.00 OFF from our regular $388.00 full-Package-Price) You will also be required to pay a $38.50 State Fee. This form is secure, private, and HIPAA Compliant.

HONOLULU WELLNESS CENTER Patient pre-appointment form click contract.

By Clicking the “Submit” CLICK AGREEMENT acknowledges that you agree to the following:

I attest that I will not engage in the diversion of cannabis. I understand that fraudulent distribution or resale of cannabis is a felony.

I understand that when under the influence of cannabis driving is prohibited and machinery should not be operated.

I understand all medical cannabis (all cannabis), should be kept away from children.

I acknowledge consumption of marijuana or marijuana manufactured products on the Honolulu Wellness Center, Plaza or anywhere on premises of the Honolulu Wellness Center is prohibited.

I understand there may be health risks associated with using cannabis.

I understand I may not distribute marijuana to any other individual.

I agree not to bring any weapons or anything that can be used as a weapon into Honolulu Wellness Center facilities.

I understand that I must have a valid government-issued identification (Driver’s License, State ID, or Passport.) during every visit to the Honolulu Wellness Center.

I agree at all times to abide by Hawaii law in regard to my use of medical cannabis and hereby release and waive all claims against Honolulu Wellness Center, Infinity Life Center, Paul Klink CMCC, Michael Pasquale DO, our staff, our vendors, our family, and associates from any and all liability related to my use of medical cannabis.

I certify that I the above is true and correct and agree to hold harmless and release Honolulu Wellness Center ~ Cannabis Card Clinic, and its officers, managers, agents, and employees of any liability related to the use of medical cannabis purchased at the Honolulu Wellness Center, during house calls for patients who can’t come into the office, or services offered by Honolulu Wellness Center.

I will always be honest and accurate in all my dealings with the Honolulu Wellness Center and it's staff.

I will not break any laws in any regards.

Agreed by Clicking Submit Button. Mahalo!

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