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Step-1: Fill the Application form
California - CA
Upload your DL (front side)
Upload your old Recommendation
Step-2: Medical symptoms
What is/are the main medical problem(s) which you currently have or have had in the past?
HIV/AIDS
Nausea
Fibromyalgia
Seizures
Arthritis
Muscle Spasm
Migraine Headaches
Anxiety
Chronic Pain
Glaucoma
Cancer
Trouble Sleeping
Loss of Appetite
Weight Loss
Other
Are you taking any prescription medications or herbs?
No
Yes
Do you have any allergies to any medications?
No
Yes
Do you smoke tobacco?
No
Yes
Do you drink alcohol?
No
Yes
Have you experienced or been diagnosed with any of the following?
Depression
Bipolar Disorder
Schizophrenia
Suicidal thoughts
ADHD
None
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