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2011
May
P
PatientSciences
PatientSciences
0%
Exit Survey »
Welcome to our Patient Registration Program.
Using a cell phone, message proof of your legal MMJ Patient status using a clear legible image of your OMMP Package and OMMP Stamp or Proof of mailing to:
MMJCARD@ PatientSciences.com
Please describe the OMMP Paperwork Package or OMMP Card image sent?
Package - STAMPED by the OMMP Office / My State's Exact Legal Equivalent.
Package - With PROOF OF MAILING CERTIFICATE from the USPO.
Card - OMMP CARD / My State's Exact Legal Equivalent.
Issue - I could not send my Package Electronically.
Date of OMMP Office Stamp or USPO Receipt of Mailing...
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Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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2024
*
First Name
:
*
Last Name
:
*
Address 1
:
Address 2
:
*
City
:
*
State
:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
*
Zip
:
Phone
:
Email Address
:
Identify your Health Concerns...
A.D.D.
ADDICTION
ALLERGY
A.L.S.
ALZHEIMER’S
ANGER
ANXIETY
ARTHRITIS
ASTHMA
CACHEXIA
CANCER
CHEMOTHERAPY EFFECTS
CIRCULATION
CYSTIC FIBROSIS
DEPRESSION
DIABETES
DSM DIAGNOSIS
DYSTONIA
END OF LIFE, GENERAL
FIBROMYALGIA
GI DISORDER
GLAUCOMA
HEAD PAIN
HEPATITIS C
HIV/AIDS
HYPER-ACTIVITY
IMBALANCE
INFLAMMATION
INSOMNIA
MIGRAINES
M.R.S.A.
MULTIPLE SCLEROSIS
NAUSEA
NAUSEA, SEVERE
NIGHT TERRORS
OSTEOPOROSIS
P.T.S.D.
PAIN
PAIN, SEVERE
PRURITUS
RX SIDE EFFECTS
SEIZURES
SPASMS
STRESS
TRAUMA
Other
ACTIVE DAY - Select your Preferred Activity Level...
-- Select --
1 - Extremely Active
2 - Very Active
3 - Active
4 - Somewhat Active
5 - Balenced
6 - Somewhat Sedate
7 - Sedate
8 - Very Sedate
9 - Extremely Sedate
ACTIVE DAY - Select your Preferred Effects...
+ :: STRONG EFFECTS
- :: MILD EFFECTS
! :: RAPID ONSET
… :: DELAYED ONSET
Ab :: ACTIVE BODY
Ae :: ANTIEMETIC
Am :: ACTIVE MIND
Ap :: APPETITE
Ar :: AROMA
As :: AESTHETIC
At :: ANTI-TUSSIVE
Bt :: BITTER TASTE
Bx :: BODY EFFECTS
C :: CALMING
Cl :: COUCH LOCK
Cm :: CLEAR MIND
Cr :: COLOR
D :: DREAMY
Dn :: DENSE
Dx :: DEPRESSIVE EFFECTS
E :: EUPHORIC
Ed :: EXTENDED DURATION
F :: FOCUS
G :: GIGGLY
H :: HAPPY
Hx :: HEAD EFFECTS
I :: INTROSPECTIVE
Ir :: IRRITABLE
L :: LUCID
N :: NUMB
P :: PEACEFUL
Po :: POSITIVE
Ps :: PSYCHEDELIC
R :: RELAXING
Sd :: SHORT DURATION
Sn :: SENSUAL
So :: SOCIAL
St :: SWEET TASTE
Sx :: SEXUAL
Sy :: STONEY
T :: TALKATIVE
Z :: SLEEPY
Other
SEDATE DAY - Select your Preferred Activity Level...
-- Select --
1 - Extremely Active
2 - Very Active
3 - Active
4 - Somewhat Active
5 - Balenced
6 - Somewhat Sedate
7 - Sedate
8 - Very Sedate
9 - Extremely Sedate
SEDATE DAY - Select your Preferred Effects...
+ :: STRONG EFFECTS
- :: MILD EFFECTS
! :: RAPID ONSET
… :: DELAYED ONSET
Ab :: ACTIVE BODY
Ae :: ANTIEMETIC
Am :: ACTIVE MIND
Ap :: APPETITE
Ar :: AROMA
As :: AESTHETIC
At :: ANTI-TUSSIVE
Bt :: BITTER TASTE
Bx :: BODY EFFECTS
C :: CALMING
Cl :: COUCH LOCK
Cm :: CLEAR MIND
Cr :: COLOR
D :: DREAMY
Dn :: DENSE
Dx :: DEPRESSIVE EFFECTS
E :: EUPHORIC
Ed :: EXTENDED DURATION
F :: FOCUS
G :: GIGGLY
H :: HAPPY
Hx :: HEAD EFFECTS
I :: INTROSPECTIVE
Ir :: IRRITABLE
L :: LUCID
N :: NUMB
P :: PEACEFUL
Po :: POSITIVE
Ps :: PSYCHEDELIC
R :: RELAXING
Sd :: SHORT DURATION
Sn :: SENSUAL
So :: SOCIAL
St :: SWEET TASTE
Sx :: SEXUAL
Sy :: STONEY
T :: TALKATIVE
Z :: SLEEPY
Other
SPECIAL PURPOSE - Select your preferred Activity Level
-- Select --
1 - Extremely Active
2 - Very Active
3 - Active
4 - Somewhat Active
5 - Balenced
6 - Somewhat Sedate
7 - Sedate
8 - Very Sedate
9 - Extremely Sedate
From
Discrete Table of Effects
SPECIAL PURPOSE - Select your Preferred Effects...
+ :: STRONG EFFECTS
- :: MILD EFFECTS
! :: RAPID ONSET
… :: DELAYED ONSET
Ab :: ACTIVE BODY
Ae :: ANTIEMETIC
Am :: ACTIVE MIND
Ap :: APPETITE
Ar :: AROMA
As :: AESTHETIC
At :: ANTI-TUSSIVE
Bt :: BITTER TASTE
Bx :: BODY EFFECTS
C :: CALMING
Cl :: COUCH LOCK
Cm :: CLEAR MIND
Cr :: COLOR
D :: DREAMY
Dn :: DENSE
Dx :: DEPRESSIVE EFFECTS
E :: EUPHORIC
Ed :: EXTENDED DURATION
F :: FOCUS
G :: GIGGLY
H :: HAPPY
Hx :: HEAD EFFECTS
I :: INTROSPECTIVE
Ir :: IRRITABLE
L :: LUCID
N :: NUMB
P :: PEACEFUL
Po :: POSITIVE
Ps :: PSYCHEDELIC
R :: RELAXING
Sd :: SHORT DURATION
Sn :: SENSUAL
So :: SOCIAL
St :: SWEET TASTE
Sx :: SEXUAL
Sy :: STONEY
T :: TALKATIVE
Z :: SLEEPY
Other
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