I accept the following terms:By checking off each of the following, you are agreeing to the terms and conditions herein.
You MUST agree to all terms for us to approve your Dr. appointment.

My appointment is for a: *New CertificationRenewal

Card Delivery *The Greener Institute is providing our patients with a streamlined process that expedites the delivery of the cards.

I understand it is an average of 7-14 working days to receive my card. Since The Greener Institute has no control of mailing, I understand that the card may take up to 21 working days or longer in rare cases.

The card will be shipped to the address on my drivers license unless I supply a change of address to The Greener Institute before I see the doctor.

Appointment Time *

Even though I have selected a time on the calendar the doctor works within a window of time. I will be added to the list for the doctor to contact me on my appointment day between the hours of 9-3pm. Generally the doctor will not call you he will send you a text. The text will contain a link that I will click on to start the video conference.

State Account *I would like the Greener Institute to set-up my State AccountI have/will set-up my own State AccountUnsure. Please provide more info.

If we are setting up your account:

I need to supply my Pa drivers license or state ID in order for the Greener Institute to set up my account with the state. If I have a change of address I will also send that to the greener institute.

I will receive an email from the State indicating that “Your account is set-up and you can get your mmj card but need to find a doctor to get certified”. Please ignore that email since we are providing the certified doctor.

I will not change my password without notifying the Greener Institute, or it will cause delays in receiving my card.

If you have or are setting up your account: I am responsible for paying the state fee of $50.00

State Certification Emails If the Greener Institute is setting up my account.

Once you are certified by the doctor, the State will send the following 2 emails:

The 1st email will be from the state informing me that I have been approved by the doctor to get my mmj card, and I should go into my state account and pay $50. I WILL NOT GO INTO MY ACCOUNT TO PAY the 50.00 state feeThe Greener institute will pay the $50 with my credit card on file. If I go into my account and pay the fee, my card can be delayed.

The 2nd email will be a receipt for the $50 dollar state fee paid in your behalf by The Greener Institute with my card on file. If I do not receive this email 24 hours after my doctor's appointment, I will contact The Greener Institute.

State Certification Emails If I setup the state account.

The 1st email will be from the state informing me that I have been approved by the doctor to get my mmj card, and I should go into my state account and pay $50. I WILL GO INTO MY ACCOUNT TO PAY the $50.00 state fee

The 2nd email will be a receipt for the $50 dollar state fee paid.

Renewal *

Fees *

Total fees for renewals are $125 (does not include $50 state fee).

I understand that if I am applying for a recertification, I am responsible for going into my state account and paying the state the $50 fee.

Total fees for new certification is $149 (does not include $50 state fee). An additional $50.00 may be charged if The Greener Institute is setting up my state account.

Fee for a comprehensive consultation with the doctor is $150. Save $25 if combined with a certification or re-certification.

Refund Policy *

I will receive a 100% refund if the doctor does not certify me.

If I decide to cancel my appointment after my deposit has been made, I will receive 40% of my payment back.

Patient Disclosure, Release, and Waiver of Liability

Disclosure:

The Greener Institute provides clinical guidance from physicians on using cannabis to treat certain diagnoses, including recommendations on the strain, formulation, and dosing principles. Cannabis can have contraindications or produce side effects. You should not use Cannabis products if you are pregnant have a personal or family history of a Psychotic Disorder including but not limited to Schizophrenia, Depression with Psychosis, Thought Disorder, Postpartum Depression, and Bipolar Affective Disorder Type I. If you experience any side effects from cannabis, you should immediately stop use and contact your primary care physician and/or cannabis physician immediately and if they are immediately unavailable, go to the nearest hospital emergency room. If your ability to operate a motor vehicle is impaired, you should call 911 for an ambulance.

Cannabis is considered an experimental treatment, and more research is being performed to explore the benefits and risks of use. Cannabis use is not approved by the Food and Drug Administration. You should consult with your Primary Care Physician prior to the use of Cannabis products. Other issues outside of cannabis treatment should be directed to a primary care physician or specialist in a given field.

Release and Waiver of Liability:

By accepting this Disclosure, Release, and Waiver of Liability, I hereby acknowledge that: *

I hereby release and forever discharge the Greener Institute, its physicians, firms, representatives, administrators, agents, officers, employees, subcontractors, affiliates, assigns, heirs, executors, all other persons personally or corporately, jointly and severally, associated in anyway whatsoever with the process of obtaining my Cannabis Card, medical guidance through the above parties, arising out of my use of cannabis products from any and all claims, demands, actions, causes of action or suits of any kind or nature whatsoever.

And acknowledge that: *

I am over (18) years old and have fully read, understand the terms and accept them knowingly, intelligently and voluntarily and have not been promised anything in exchange for doing so.

Digital Signature *

By typing your name, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature and consent to be legally bound by this agreement's terms and conditions.

Signature *

Date *

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