Pre-Registration

TO BECOME A REVOLUTIONARY CLINICS REGISTERED MARIJUANA PATIENT, COMPLETE THE PRE-REGISTRATION FORM:

Complete the New Patient Pre-Registration Form

Become a Rev Clinics patient by submitting the online form below:

Patient Pre-Registration

Once submitted, you can place an order right away!
  • Exactly as it appears on your MMJ Card
  • What do you prefer to be called?
  • MM slash DD slash YYYY
  • Exactly as it appears on your MMJ Card
  • This field is for validation purposes and should be left unchanged.