COMP Membership Application
Compassionate Membership Program.
1. AIDS/ HIV
5. Chemotherapy Patients
10. Hepatitis C
13. Peripheral neuropathy
14. PTSD US Military Combat Veterans.
16. Sickle cell
17. Sleep Disorder
19. Ulcerative colitis
This information is seen by only one person,
(Chief Executive Volunteer)
This information is destroyed, upon confirmation by your doctor. (Will hold up to, 30 days. Pending confirmation)
Verify your applicable diagnosed illness.
Aids / HIV
PTSD US Military Combat Veteran
State issued photo identification
Medical cannabis certification.
Documentation, or certification, of illness & diagnosis.
Please provide any form of documentation, or physicians statement.
US Military "COMBAT" Service
Must accompany physicians diagnosis of PTSD
Physician's Name, or the Name of Practice
Physician's city and state of Practice
We can not provide medicine without verification by your physician.
You must inform your physician, authorizing our pending inquiries, of your condition and status.
We will allow up to 30 days for verification.
Yes, I understand
Do we have your authorization to contact your physician for verification of these facts?
1. You will be contacted by email.
2. You will be added to our Comp Members Club, for 6 months.
4. You may use, "Members Order Form"
You must reapply every 6 months to renew.
You will receive an invoice of your order if approved.
May take up to 24 hours for first time patients.