Medical Cannabis Patient Application
Medical Cannabis Registry Applications
Applicants should consider discussing medical cannabis with their physician prior to beginning an application. All applicants, except for veterans receiving care at a VA facility, must provide written certification from their physician for the use of medical cannabis.
Patients and caregivers may now submit medical cannabis registry applications online through a secure website.
Persons unable to use the online application may mail application materials to:
Illinois Department of Public Health
Division of Medical Cannabis
535 W. Jefferson St.
Springfield, IL 62761-0001
Required application materials:
- Patient Application Form (Includes Fingerprint Consent Form)
- Caregiver Application Form
- Physician Certification Form
- Reviewing Physician Certification Form
- Waiver for Increasing the Adequate Supply of Medical Cannabis Form
- Illinois Department of Financial and Professional Regulation Fingerprint Vendor List
If you are a veteran receiving care from a Veterans Affairs facility, rather than a physician recommendation form you will need to request VA Form 10-5345, to authorize the release of your medical records, and VA Form DD214 to certify character and dates of service.
Medical Cannabis Registry Applications – TERMINAL ILLNESS
Persons diagnosed with a terminal illness with a life expectancy of six (6) months or less may apply for a medical cannabis registry identification card valid for six months. There is no application fee.
Applications cannot be submitted on-line.
Qualifying patients (Adults and Persons under age 18):
- Be a resident of the State of Illinois at the time of application and remain a resident during participation in the program
- Have been diagnosed with a terminal illness with a life expectancy of six (6) months or less
- Submit a complete application
- Make sure your physician completes and signs the physician confirmation of diagnosis of terminal illness. This form must be signed in blue ink. The in-person physical examination must take place within 90 days of the application submission date.
- Not hold a school bus permit or Commercial Driver’s License
- Not be an active duty law enforcement officer, correctional officer, correctional probation officer, or firefighter.
- Select a caregiver, if desired (persons under age 18 may have two caregivers)
Veterans receiving care at a U.S. Department of Veterans Affairs (VA) Facility:
- Submit a copy of your DD-214 showing dates of service and character of service (type of discharge)
- Provide a copy of your medical records from the VA facility for the last 12 months.
- Complete the Attestation of Terminal Illness (page 6 of the application package). This form must be notarized.
Required application materials:
Frequently Asked Questions
Department of Public Health – Division of Medical Cannabis
535 W. Jefferson Street
Springfield, Illinois 62761-0001
Toll-free (855) 636-3688
(217) 782-3300 or
TTY (hearing impaired use only) 800-547-0466
Department of Revenue
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- Parkinson's Disease
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