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.
One or more injuries that significantly interferes with daily activities
Moderate to severe chronic pain
Acquired immune deficiency syndrome (AIDS)
Hepatitis C, currently receiving antiviral treatment
Positive status for HIV
*Post traumatic stress disorder (PTSD)
Spinal cord injury/disease
Traumatic brain injury
If yes, please review symptoms.
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
Constant or severe nausea
Moderate to severe vomiting
Severe, persistent muscle spasms
Agitation of Alzheimer's
If yes, please continue below.
Speak with your physician or Advanced Practice Registered Nurse about therapeutic cannabis.
If your physician agrees, have them fill out the physician form.
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.
Access the government-issued application forms at the DHHS website.
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: