PATIENT & PRACTITIONER

Forms

Patient Forms

Accessing Medical Cannabis (AMCPR)

There are three avenues for Hybrid Pharm to help you gain access to Medical Cannabis

Option One: Medical Document

This is a Medical Cannabis prescription form for your Healthcare Practitioners to complete and return to us.

Option Two: 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 Three: 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.

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 and 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

Start your Hybrid journey today.

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