Registration

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Doctor's Name:

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Your Patient ID Number:

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Terms & Conditions

To qualify to become a member, you must

1. Be 18 years of age or older

2. Show California State issued ID card

3. Have a doctor’s recommendation

4. Been diagnosed with an illness known to be treatable or alleviated through the use of therapeutic marijuana

5. Agree to the limits on amounts of medical marijuana according to state (CA H&S Code 11362.5 & 11362.7) and local law

6. Agree never sell or otherwise distribute medication obtained at Serenityleaf.com. Your membership will be revoked if you do so.

We're very aware of privacy concerns for individuals wishing to obtain information or to obtain medical marijuana. Any information that you submit to us will be held in the strictest of confidence

As per California Health & Safety Code §11362.5, I hereby certify that I am a patient, 18 years or older, suffering from serious illness and have obtained a recommendation or approval from a licensed physician in the state of California to use medical cannabis (marijuana) in treating my illness. I hereby designate Serenityleaf.com as my “Primary Caregiver,” in accordance with California Health and Safety Code §11362.5(d) and §11362.5(e), which reads as follows:
(d) Section 11357, relating to the possession of marijuana, and section 11358, relating to the cultivation of marijuana, shall not apply to a patient, or to the patient’s primary caregiver, who possesses or cultivates marijuana for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician.
(e) For the purposes of this Section, ‘primary caregiver’ means the individual designated by the person exempt under this act who has consistently assumes responsibility for the housing, health or safety of that person.
- I agree I will rely on Serenityleaf.com as the primary source of medical marijuana as a matter of my personal health and safety. This designation shall remain in effect (1) for one year from the date indicated, (2) or until I revoke this designation, (3) or until I designate another individual as my primary caregiver, (4) or upon expiration of my physician’s recommendation.
- I authorize my recommending physician to verify his or her recommendation or approval for the use of medical cannabis.
- I will provide only the most correct, complete and accurate information to Sereneityleaf.com.
- I am not a law enforcement agent or employee, or employee of any state or federal drug enforcement agency.

Serenityleaf.com closely follows the Federal Doctor-Patient Confidentiality (HIPPA) laws. Patient records will only be disclosed at the written request of the patient.

All membership records are kept confidential and stored securely

As responsible members to our community we do not offer mail orders and do not serve minors. 18 and over Only!