CONSENT FOR TREATMENT BY CC IN CT/MEDICAL MARIJUANA USE

CONSENT FOR TREATMENT BY CANNABIS CERTIFICATION IN CENTER TOWNSHIP AND MEDICAL MARIJUANA USE
I am being evaluated for a physician's recommendation for Medical Cannabis. The physician will make recertification and recommendation based, in part, on the medical information I have provided. I hereby acknowledge that I have not misrepresented my medical condition to obtain this recommendation and it is my intent to use Medical Cannabis only as needed for the treatment of my medical condition, not for recreational or non- medical purposes. I understand that it is my responsibility to be informed regarding state and federal laws regarding the possession, use, sale/purchase and/or distribution of Medical Cannabis. I have been informed of and understand the following.

SEE PDF FORM - 3 pages - below and read them. At the bottom of this form you will sign to acknowledge that you understand these terms of consent.
I, the undersigned, acknowledge that I have read the Release of Liability and Acknowlegements, Agreements, Disclosures and Informed Consent. By signing below I agree to follow these policies.
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CONSENT FOR TREATMENT BY CANNABIS CERTIFICATION IN CENTER TOWNSHIP AND MEDICAL MARIJUANA USE