Pre-Qualifying Form

Privacy & Confidentiality
Your medical information is secure and handled with the utmost discretion.

Are you over 18?

Are you a new patient or are you renewing?

Are you a medical tourist?

What airport will you be flying into?

Where you from?

Arrival Date

We apologize but we cannot guarantee that there will be cannabis available before March 1st. If you have questions, please contact us via WhatsApp.

Departure Date

What province or territory are you located in?

Condition you're suffering from

First Name

Last Name

Date of Birth

Phone Number

I agree that I have read the Privacy Policy. www.curavidacannabisclinics.com/privacy-policy/

Unfortunately our services are not available for your age range. Please return at a later date.