Patient Application

    Our organization provides COMPASSIONATE CARE SERVICES for qualified members IN ACCORDANCE WITH CALIFORNIA HEALTH AND SAFETY CODE Sec. 11362.5(B)(1)(A) & 11362.7(H) & 11362.75. The Imperial Roots is also in compliance with California Proposition 215 and SB 420.

    Patient Information
    Please upload a clear copy of your current CA ID/DL. Your CA ID/DL must be valid, and all first time patients must show ID upon delivery. No exceptions.
    Max file size: 20MB

    Recommendation Information

    Please upload a clear copy of your entire Dr.'s recommendation. All information must be clearly visible in order to expedite verification.
    Max file size: 20MB
    Vendor Information - Optional
    PATIENTS WHO WOULD LIKE TO BE CONSIDERED AS A VENDOR WITH THE IMPERIAL ROOTS, PLEASE PROVIDE US WITH ONE OF THE FOLLOWING DOCUMENTS. ALL VENDOR APPLICATIONS WILL BE REVIEWED AND WE WILL CONTACT YOU WITHIN 1 TO 3 BUSINESS DAYS TO LET YOU KNOW IF WE ARE INTERESTED IN CARRYING YOUR PRODUCT(S).
    Product(s)
    Please upload a file, which should include all the items you would like us to consider.
    Max file size: 20MB
    By submitting this form for patient verification, I understand and agree as follows:

    I am at least 18 years of age. I am a patient and/or farmer with a valid California ID/Driver's License, and a medical marijuana recommendation issued by a licensed California physician in good standing, who is able and willing to use their services to support our organization's purpose and principles. I agree not to distribute marijuana to non-members or divert marijuana for non-medical use. I designate The Imperial Roots as my care providers. I agree to observe all the policies and procedures of The Imperial Roots and compensate for the services rendered by The Imperial Roots. I hereby authorize my treating doctor to release medical information regarding my diagnosis and condition to The Imperial Roots, if needed for optimal patient consultation.