Follow the steps to successfully complete your application

1. Click 'Get Form' button to access the application form and open it for editing.
2. Indicate whether this is a new application or a renewal by selecting the appropriate check box.
3. Provide your qualifying patient information, including your full name, date of birth, address, and contact details. Ensure all fields are accurately filled out.
4. Complete the physician information section by entering the physician's name, practice details, and contact information.
5. Prepare proof of residency by attaching copies of required documents such as a utility bill or bank statement.
6. Include a recent photograph that conforms to specified requirements regarding size and background.
7. Ensure the physician has completed the Physician Written Certification Form, and prepare any additional documents if applicable (for veterans).
8. Submit the UCIA fingerprint consent form as part of your application, including details on how to obtain fingerprints.
9. Select a medical cannabis dispensary zone by checking one of the listed districts.
10. Include the appropriate application fee on the form, and specify the payment method.
11. Review the certifications section carefully. Sign and date the application to attest that the information provided is true and accurate.
12. After completing the form, save your changes and consider downloading or printing a copy for your records before submitting it.

Begin your application process online today to secure your registry identification card.