FORMS
Patient Forms
Accessing Medical Cannabis (ACMPR)
There are three avenues for Hybrid Pharm to help you gain access to Medical Cannabis
Option #1: Medical Document
This is a Medical Cannabis prescription form for your Healthcare Practitioners to complete and return to us.
Option #2: Referral Form
Healthcare Practitioners who are not comfortable prescribing Medical Cannabis can complete and return the referral form, allowing you to consult with one of our specialists.
Option #3: Medical Records Release Form
Allows us to request a copy of your medical records for our specialists to review. Alternatively, you may request these medical records from your Healthcare Practitioners and provide them to us.
Influenza Vaccine Screening Form
Looking to get ahead of the flu season? Come to Hybrid Pharm for your seasonal Influenza shot!
Complete your Screening Questionnaire For Inactivated Injectable Influenza Vaccine before your visit and reduce your wait time! Drop in’s welcome or call to make an appointment.
Practitioner Forms
HYBRID PHARM PROVIDES THE ACCESS, EDUCATION & RESOURCES YOUR PATIENT NEEDS
At Hybrid Pharm, our certified, medically trained staff assists patients with access, information and education in regards to their personal medical cannabis journey.
We educate patients on licensed producers, strain selections, and safe and effective use. Through consistent monitoring and follow up, feel at ease knowing your patients are cared for.
RX forms: By filling out this form you consent to your patient having access to the ACMPR system. The grams per day and duration period spots MUST be filled out appropriately. Questions? Contact Us.
