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.

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.

Insurance Resources

This is the place insurance claim submissions, authorization forms for medical cannabis, or even just learning more.

Insurance Forms

Download prior authorization request and submission forms from various insurance providers here.

Blue Cross Authorization Form

Canada Life Cannabis Authorization Form

Green Shield Claim Submission Form

SSQ Authorization Form

Sunlife Authorization Form

Insurance Information

Here you can find some convenient info PDFs about Medical Cannabis programs and plans.

Manulife Medical Cannabis Plan

Sunlife Group Benefits Primer

Sunlife Medical Cannabis Plan

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