Apply with VIMM

Please fill in as much as information as you feel comfortable submitting. We require at least your name and one phone number, but the more information you can provide us with, the better we can address your unique situation.

We at VIMM take your privacy very seriously. All information submitted is held in the strictest confidence, and NONE of your personal information will be stored online. For more details, please see our privacy policy.

ALERT: Because of the high volume of new patient requests coming in, we are referring patients with smaller prescriptions in the Vancouver area to a top quality dispensary we recommend, Karuna Medicinals Society. You can download their membership application form here, as well as a member checklist to help you assemble what you’ll need for your application. For some illnesses, you can provide a physicians statement of diagnosis instead of a copy of your MMAR license.

1. Your Contact Information

What times are you available at this number?

What times are you available at this number?

Minors are only permitted to apply with written parental consent and a statement from a doctor who will sign their MMAR application forms.

2. Your Application Type


Please explain briefly your reason(s) for applying, and let us know how we can best help you.

If you are applying as a patient, please complete sections 3 & 4 as well. Otherwise, proceed to section 5

3. Your Medical Background

If you answered "Yes", please enter your MMAR Information. If you answered "No", skip the MMAR Information section and proceed to the Health Canada Application section.

MMAR Information

Health Canada Application


YesNo

Has your doctor agreed to sign your Health Canada forms?
YesNo

Your Condition(s)

Check any of the following conditions that you have been diagnosed with and/or are currently suffering from:

Please describe as much as you can about your condition, diagnoses, history and the treatments you have already tried. Include any medications you have already used and how they have helped or not helped.

4. Your Medicine and Usage

Strains

Are there particular strains that you find are more effective in treating your symptoms?

Methods

What are your preferred methods of consuming medical marijuana?

5. Legal Disclaimers

I have read, understood and agreed to the privacy policy (view)

I am a Canadian citizen or permanent resident and currently reside inside Canada

I am over the age of 18 or have written parental permission to apply for VIMM's services

Van Isle Medical Marijuana

Medical Benefits of Marijuana

  • Relieves chronic pain from a variety of causes and reduces the need for addictive narcotic pain killers.
  • Increases appetite, relieves nausea and vomiting, reduces pain and helps patients sleep while undergoing chemotherapy.
  • Improves appetite, may reduce pain and helps HIV patients sleep.
  • May reduce brain and lung tumors and slow the growth of cancer, may stop breast cancer from spreading throughout the body.

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