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Rhode Island Department of Health Rhode Island Department of Health
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Program Activities
Office of Health Professionals Regulation
3 Capitol Hill
Room 205
Providence, RI 02908
401-222-2828
401-222-1272 Fax
Charles Alexandre, RN, MSN, Chief

 

 

Office of Health Professionals Regulation

Medical Marijuana Program (MMP)

  Registration Requirements | Frequently Asked Questions (FAQ's) pdf
Application Request

Applications for registration must be downloaded and printed. The completed form should be mailed to the address noted on the application. Forms will not be accepted via email or fax.

All forms are in pdf  pdf format.

Download; Then Print and Complete the Entire Application and required forms.

Instructions and Applications:

NOTE:  Please provide your current contact information (phone/email) so that we may schedule you for your photo identification card upon approval of your application.

  • New Application - This application includes the following:
    Instructions
    Patient Form
    Physician Form
    (Minor Form) this form must be completed only if the patient is under the age of 18.
  • Change Form - This form must be completed if any information has changed since you have been registered.

 

 

 

Licensing Unit - New Hours of Operation

Highlights

Change of Address Form pdf

Duplicate License Request Form pdf

Data Request Release Form pdf

Tax Payer Status Affidavit pdf

Information Regarding Complaints against Health Professionals regulated by Health Services Regulation

You will need the free Adobe Acrobat Reader® to view or download PDF documents. If you have difficulty with a PDF download, please try these solutions

 
Rhode Island Department of Health • 3 Capitol Hill • Providence RI 02908
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