Medical Release Form
Download Medical Release Form

Download, print, and fill out this form to get your records from your PCP, hospital or any other healthcare professional you have seen.

Specifically, we need your diagnosis and any prescription history you have.

Are you unsure if you qualify? The list of conditions in the Amendment left it up to the physician to determine so please reach out and lean on our experience to help get you qualified.

  • Valid Missouri ID
  • Medical Records
  • 18 + Years Old
  • A Qualifying Condition