Get a Card

Find Out If You Qualify

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 forms to apply to the program here. Effective June 10, 2016, 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.

Step 2

Access the government-issued application forms at the DHHS website.

You can access the application forms here, or you can view the complete list of state forms and information about the Therapeutic Cannabis Program here.

Review all patient instructions.

Complete the application and submit the following:

Written certification completed by provider


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
  • 29 Hazen Drive
  • Concord, NH, 03301