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)
Austism Spectrum Disorder
Acquired immune deficiency syndrome
Alzheimer's disease
Amyotrophic lateral sclerosis
Cancer
Chronic pancreatitis
Crohn’s disease
Ehlers-Danlos syndrome
Epilepsy
Glaucoma
Hepatitis C
Lupus
Multiple sclerosis
Muscular dystrophy
One or more injuries or conditions that has resulted in one or more qualifying symptoms listed below
Parkinson's disease
Positive status for human immunodeficiency virus
Spinal cord injury/disease
Traumatic brain injury
Ulcerative colitis
If yes, please review symptoms.
Or do you have at least one of the following stand alone conditions? (Click to Open)
Moderate to severe post-traumatic stress disorder
Moderate to severe chronic pain
Severe pain that has not responded to previously prescribed medication or surgical measures or for which other treatment options produced serious side effects
Autism spectrum disorder (age 21 or older)
Autism spectrum disorder (under age 21) (requires a consultation with a certified provider of child and/or adolescent psychiatry, developmental pediatrics, or pediatric neurology, who (1) confirms that the autism spectrum disorder has not responded to previously prescribed medication or that other treatment options produced serious side effects and (2) supports certification for the use of therapeutic cannabis)
If yes, please continue below.
AND
Do you have at least one of the following symptoms? (Click to Open)
Agitation of Alzheimer’s disease
Cachexia
Chemotherapy-induced anorexia
Constant or severe nausea
Moderate to severe vomiting
Constant or severe nausea
Seizures
Severe pain that has not responded to previously prescribed medication or surgical measures or for which treatment options produced serious side effects
Severe, persistent muscle spasms
Wasting syndrome
Moderate to severe insomnia
If yes, please continue below.
Great! Here’s How You Can Register
Step 1
Speak with your physician or other accepted provider about therapeutic cannabis:
A NH physician licensed to prescribe drugs to humans under RSA 329
A NH advanced practice registered nurse (APRN) licensed to prescribe drugs to humans under RSA 326-B:18
A NH physician assistant licensed pursuant to RSA 328-D, who has the express consent of the supervising physician
A physician or APRN licensed to prescribe drugs to humans under state licensing laws in Maine, Massachusetts, or Vermont, and who is primarily responsible for the patient's care related to their qualifying medical condition
If your qualified provider agrees, have them fill out the physician form.
You can view the forms to apply to the program here.
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
