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Online Registration Form

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Applicant Information

Complete your registration online instantly. Along with the registration form, we will require the Medical Document from your physician to verify your prescription.

Mail:
Solace Health
PO Box 43125
Mississauga, ON, L5B 4A7
or
Secure fax: 1-844-576-5223

If you are submitting this on behalf of someone else, please go back and select CAREGIVER.

If you need assistance at any point please call us at 1-844-976-5223.

ARE YOU APPLYING WITH A REGISTRATION CERTIFICATE ISSUED BY THE MINISTER OF HEALTH?

NOTE: THIS IS DIFFERENT FROM OUR STANDARD REGISTRATION PROCESS AND WILL NOT APPLY TO MOST PATIENTS. IF YOU’RE UNSURE, SELECT ‘NO’.

Shipping /
Mailing
Information

Please provide the primary residence of the Applicant. Primary residence must be within Canada.

Primary Address of Applicant
IS YOUR SHIPPING ADDRESS DIFFERENT FROM YOUR PRIMARY ADDRESS

Authorization

THE APPLICANT OR CAREGIVER FOR THE APPLICANT ACKNOWLEDGES THAT THEY HAVE READ, UNDERSTOOD AND AGREE THAT THE APPLICANT ORDINARILY RESIDES IN CANADA. THE INFORMATION IN THIS APPLICATION AND THE ACCOMPANYING MEDICAL DOCUMENT OR REGISTRATION CERTIFICATE IS CORRECT AND COMPLETE. THE MEDICAL DOCUMENT OR REGISTRATION CERTIFICATE IS NOT BEING USED TO SEEK OR OBTAIN MEDICAL CANNABIS FROM ANOTHER SOURCE. THE ORIGINAL MEDICAL DOCUMENT MUST BE RECEIVED BY Solace Health IN ORDER FOR Solace Health TO COMPLETE THE PATIENT REGISTRATION. THE APPLICANT WILL USE MEDICAL CANNABIS ONLY FOR THEIR OWN MEDICAL PURPOSES. THE APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT MEDICAL CANNABIS IS NOT CURRENTLY APPROVED FOR USE AS A PHARMACEUTICAL DRUG IN CANADA. THE APPLICANT ACKNOWLEDGES AND AGREES THAT HE OR SHE IS USING ANY MEDICAL CANNABIS PRODUCT OBTAINED FROM Solace Health AT HIS OR HER OWN RISK, AND RELEASES Solace Health (AND ITS PARTNERS, PROVIDERS, OFFICERS, DIRECTORS AND STAFF) FROM ANY AND ALL ACTIONS, CLAIMS, COMPLAINTS AND DEMANDS FOR DAMAGES, LOSS OR INJURY WHATSOEVER ARISING DIRECTLY OR INDIRECTLY FROM THE USE OF MEDICAL CANNABIS OBTAINED FROM Solace Health. THE APPLICANT CONSENTS TO Solace Health COLLECTING AND DISCLOSING NECESSARY PERSONAL INFORMATION IN ORDER TO PROCESS THIS REGISTRATION AND TO FULFILL ORDERS FOR MEDICAL CANNABIS IN ACCORDANCE WITH THE Solace Health PRIVACY POLICY (HTTPS://Solace HealthCANNABIS.COM/PRIVACY-POLICY/). BY SIGNING BELOW, THE APPLICANT OR CAREGIVER ACKNOWLEDGES THAT THEY HAVE READ, UNDERSTOOD AND AGREE THAT: Solace Health MAY FROM TIME TO TIME USE PERSONAL HEALTH INFORMATION (I.E. YOUR CONDITION(S), PRODUCT SELECTION) ON AN ANONYMOUS AND AGGREGATE BASIS FOR RESEARCH AND/OR MEDICAL EDUCATIONAL PURPOSES. WE MAY ALSO ASK YOU TO COMPLETE SURVEYS THAT WE USE FOR RESEARCH PURPOSES, ALTHOUGH YOU DO NOT HAVE TO RESPOND TO THESE. THE APPLICANT CONSENTS TO THEIR HEALTH CARE PRACTITIONER NAMED IN THE MEDICAL DOCUMENT DISCLOSING REQUIRED PERSONAL HEALTH INFORMATION TO Solace Health FOR THE PURPOSES OF COMPLYING WITH THE REQUIREMENTS OF THE ACCESS TO CANNABIS FOR MEDICAL PURPOSES REGULATIONS (ACMPR). THE APPLICANT OR CAREGIVER UNDERSTANDS AND AGREES THAT A COPY OF THIS CONSENT AND REGISTRATION APPLICATION MAY BE PROVIDED TO THE HEALTH CARE PRACTITIONER. BY INDICATING THE APPLICANT IS A VETERAN, THE APPLICANT OR CAREGIVER HEREBY GIVES PERMISSION FOR Solace Health TO SHARE PERSONAL AND ORDER INFORMATION WITH VETERANS AFFAIRS CANADA. THE APPLICANT CONSENTS TO Solace Health SENDING EMAIL, TEXT MESSAGE AND OTHER ELECTRONIC MESSAGING FROM Solace Health AND THEIR RESPECTIVE SUBSIDIARIES, AFFILIATES, BUSINESS BRANDS AND MARKETING PARTNERS. THE APPLICANT UNDERSTANDS THAT THEY MAY WITHDRAW THEIR CONSENT AT ANY TIME. PATIENT HEREBY ACKNOWLEDGES AND AGREES THAT Solace Health DOES NOT MAKE ANY REPRESENTATIONS OR WARRANTIES WITH RESPECT TO THE QUALITY AND FITNESS OF ANY PROMOTIONAL OR ANCILLARY PRODUCT(S) PROVIDED AND/OR SOLD BY Solace Health, AND SHALL NOT BE LIABLE FOR ANY DAMAGES DIRECT OR INDIRECT THAT MAY OCCUR AS A RESULT OF ITS USE. PLEASE NOTE THAT THE CONFIRMATION OF REGISTRATION FORM IS PROOF OF LEGAL POSSESSION AND THE PATIENT CARD THAT YOU MAY RECEIVE FROM Solace Health IS NOT PROOF OF LEGAL POSSESSION. YOU MAY BE REQUIRED TO PROVIDE EITHER YOUR PATIENT LABEL ON YOUR ORIGINAL PACKAGING AND/OR THE CONFIRMATION OF REGISTRATION TO PROVE LEGAL POSSESSION WITHIN CANADA ONLY.