What's your experience with cannabis? (select all that apply) *

I currently use cannabis

I've never used cannabis before

I use cannabis occasionally

I have a valid/expired medical marijuana recommendation

What's your experience with CBD? (select all that apply) *

I use CBD occasionally

I've never used CBD before

I've tried CBD in the past

I use CBD often

First Name *

Last Name *

Email *

Phone *

By entering your phone number and accepting our SMS option, you agree that by signing up via text, you agree to receive recurring automated promotional and personalized marketing text messages (e.g. appointment reminders) from Green Leaf Cannabis Company at the cell number used when signing up. You also acknowledge that consent is not a condition for any purchase made on our site. Reply HELP for assistance and STOP to cancel. Msg frequency varies. Msg and data rates apply.

Do you agree? *

Yes

Date of Birth *

What was your sex assigned at birth? *

Male

Female

If you are pregnant or breastfeeding, you can not be certified for medical cannabis. *

I am currently pregnant

I am currently breastfeeding

I am not pregnant and not breastfeeding

Address

Street Address *

City *

State *

Postal code *

Please upload our State ID.

Your doctor will need this to verify your information.

Upload Iowa State ID *

Tell us about your health goals. Briefly describe what you'd like to achieve with cannabis or CBD *