DOWNLOAD FORMSNew Patients Forms

New Patient Intake Form

If you would like to make a preorder to keep the process quick, please fill in the form with your new patient info in advance and we can process your payment without delay!

Acceptable Payment Options
ATM/CASH- We have an on-site ATM with a $3 transaction fee, plus any out of network fees your financial institution may or may not charge.

DEBIT- There is a $2.75 transaction fee, plus any out of network withdrawal fees your financial institution may or may not charge.

PERSONAL CHECK- Written to “Takoma Wellness Center”

VENMO- Search for “JOSHBKAHN”

If you are undergoing chemotherapy at this time, please let your oncologist know that you are using cannabis, as your chemo dosage may be adjusted.

New Patient Intake Form

If you would like to make a preorder to keep the process quick, please fill in the form with your new patient info in advance and we can process your payment without delay!

Acceptable Payment Options
ATM/CASH- We have an on-site ATM with a $3 transaction fee, plus any out of network fees your financial institution may or may not charge.

DEBIT- There is a $2.75 transaction fee, plus any out of network withdrawal fees your financial institution may or may not charge.

PERSONAL CHECK- Written to “Takoma Wellness Center”

VENMO- Search for “JOSHBKAHN”

If you are undergoing chemotherapy at this time, please let your oncologist know that you are using cannabis, as your chemo dosage may be adjusted.

If you do not wish to use the form, download the PDF forms here and please email us your new patient info in advance and we can process your payment without delay!

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Medical Marijuana Program: Patient Applications

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Questionnaire

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Acknowledgment

Takoma Wellness Center © All rights reserved 2020.