PDI MEDICAL, LLC MEDICAL MARIJUANA PATIENT INTAKE FORM 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out your personal information in the 'Patient Information' section. Include your name, birth date, address, and contact details. Make sure to select your marital status and indicate if you can receive texts.
3. In the 'Choose your condition(s)' section, check all applicable medical conditions from the provided list. This helps PDI Medical understand your needs better.
4. Complete the 'Health Habits Background' section by answering questions about alcohol consumption, exercise habits, and dietary preferences. Be honest for accurate assessment.
5. Fill out the 'Family Medical History' section with known conditions affecting your parents, siblings, and grandparents.
6. Proceed to the 'Registry Card Holder Medical History' where you will indicate any medications you are currently taking and any allergies you may have.
7. Finally, review the 'Disclosures and Conditions' carefully before signing. Ensure all information is accurate before submitting.

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