This Medical Document is to be completed by your healthcare practitioner, such as a family doctor,
specialist, or in some provinces and territories, a nurse practitioner. In order to be eligible to provide
this Medical Document to you, the healthcare practitioner must have you under their professional care.
Your healthcare practitioner will use his/her professional judgment and may use this Medical Document
to authorize you to use cannabis for medical purposes.
Should you choose to access cannabis from a licensed producer, this form must be sent directly to the licensed producer of your choice. You may choose any licensed producer that is authorized to sell medical cannabis to registered clients.
Please see the Health Canada website for a list of licensed
producers. Should you wish to switch from one Health Canada licensed producer to another, you can
request that your licensed producer transfer this Medical Document to a new licensed producer of your
Should you choose to produce your own cannabis, or designate someone to produce it for you, the original of this document must be sent to Health Canada with your Registration Application Form.
Note: The College of Family Physicians of Canada (CFPC) in their guidance document commonly recommends a maximum THC concentration of 9%. Prescribers are advised to use their discretion when prescribing the dose and THC concentration for patients.
By signing this document, the healthcare practitioner is attesting that the information contained in this document is correct and complete.
This Medical Document cannot be used to register an individual or place an order for medical cannabis
unless completed and signed by an authorized healthcare practitioner. In completing and signing this
form, the healthcare practitioner must use their professional judgment and consider any applicable
standard of practice. Although the Cannabis Standard will take reasonable steps to ensure that the
information contained in this Document is current and does not contain inaccuracies, the Cannabis
Standard does not warrant the quality, accuracy or completeness of the information
For more information : firstname.lastname@example.org