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Get VT Health Care Professional Verification Form 2019-2024

300 www.medicalmarijuana.vermont.gov  Department of Public Safety [phone] [fax] [email] 802-241-5115 802-241-5230 DPS.MJRegistry@vermont.gov HEALTH CARE PROFESSIONAL VERIFICATION FORM INSTRUCTIONS: This form must be completed by the patient applicant’s health care professional and signed within the last 6 months. This form must be completed and submitted with a Registered Patient Application. The definitions below are provided to assist health care professionals when completing this form.

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