Physician's Statement for a Debilitating Medical Condition for Minors

Minor registered cardholder applicants with a debilitating medical condition must use this form when applying for the Montana Marijuana Program Registry.

A medical doctor or doctor of osteopathy must complete this form for the minor registered cardholder applicant. A second physician’s signature is required (in Part C), unless the prescribing physician (in Part A) is a licensed oncologist, neurologist, or epileptologist (16-12-508(4), MCA).

Form

• Download the Physician Statement for a Debilitating Medical Condition for Minors (PDF)