Get a Card
We understand the difficulties involved with determining patient eligibility which is why we have made it easy for New Hampshire residents! Read through the checklists below to determine if you qualify as a patient.
Do you have at least one of the following conditions? (Click to Open)
One or more injuries that significantly interferes with daily activities
Moderate to severe chronic pain
Acquired immune deficiency syndrome (AIDS)
ALS
Alzheimer's disease
Cancer
Chronic pancreatitis
Crohn's disease
Epilepsy
Glaucoma
Hepatitis C, currently receiving antiviral treatment
Lupus
Multiple sclerosis
Muscular dystrophy
Parkinson's disease
Positive status for HIV
*Post traumatic stress disorder (PTSD)
Spinal cord injury/disease
Traumatic brain injury
Ulcerative colitis
If yes, please review symptoms.
AND
Do you have at least one of the following symptoms? (Click to Open)
Severe pain for which other treatment options produced serious side effects
Severe pain not responding to previously prescribed medications or surgical procedures
Elevated intraocular pressure
Cachexia
Chemotherapy-induced anorexia
Wasting syndrome
Constant or severe nausea
Moderate to severe vomiting
Seizures
Severe, persistent muscle spasms
Agitation of Alzheimer's
If yes, please continue below.
Great! Here’s How You Can Register
Step 1
Speak with your physician or Advanced Practice Registered Nurse about therapeutic cannabis.
If your physician agrees, have them fill out the physician form.
You can view the physician form here. Effective June 10, 2016 (read more here), physicians and Advanced Practice Registered Nurses licensed in the states of ME, MA, and VT are permitted under NH state law [RSA 126-X:I, VII(a)(3)] to issue a “Written Certification for the Therapeutic Use of Cannabis” to their patients who are residents of New Hampshire.
You must have a three-month, pre-existing, patient-provider relationship.*
*There is an exception to the 3-month duration requirement [He-C 401.06(b)(1)b.].
A medical relationship between the provider and the patient may be less than 3 months in duration, provided that the provider certifies on the Written Certification:
That the onset or diagnosis of the patient’s qualifying medical condition occurred within the past 3 months; and
The certifying provider is primarily responsible for the patient’s care related to his or her qualifying medical condition.
Step 2
Access the government-issued application forms at the DHHS website.
You can access the applications forms here, or you can view the full patient application instructions here.
Review all patient instructions.
Complete the application and submit the following:
Written certification completed by provider
Digital photograph (see patient application instructions)
Upload proof of NH residency
Enclose $50 check to Treasurer, State of New Hampshire
Mail or hand-deliver application to:
- New Hampshire Department of Health and Human Services
- Therapeutic Cannabis Program
- Brown Building
- 129 Pleasant Street
- Concord, NH, 03301
