Step 1 of 2 50% Patient Name* First Last What is The Best Time To Contact You?* Morning Afternoon Evening How Do You Prefer to Communicate?* Email Telephone Both Your Contact Information* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code* Email* Enter Email Confirm Email Your Phone*Mobile #Have you changed your Health Card? If so add new number here. Expiry Date MM slash DD slash YYYY Province (Health Card)AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Financial Documents (If Applicable) Drop files here or Select files Accepted file types: jpeg, jpg, png, pdf, Max. file size: 100 MB, Max. files: 1. You can upload financial document here.Click the following link to Submit the Spectrum Cannabis digital form: Spectrum Therapeutics Digital Or download the form by clicking this link to the PDF version and upload once it is filled. Spectrum Therapeutics PDF To save this form and return to complete later click the Save and Continue Later link bottom of this page.Upload Spectrum Therapeutics HereAccepted file types: pdf, jpg, png, Max. file size: 100 MB.Signature*Date Signed* MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
