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Meet With Our Pharmacist

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GREAT NEWS!

WE DELIVER TO YOUR AREA! QUALIFYING NEW YORKERS CAN REGISTER FOR AN ONLINE ACCOUNT AND SUBMIT ONLINE ORDERS FOR HOME DELIVERY.

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YOUR INFORMATION WAS SENT.
OUR TEAM WILL BE REACHING OUT TO YOU.

WE DO NOT DELIVER TO YOUR AREA AT THIS TIME.

VISIT OUR STORE TO SHOP OUR PRODUCTS
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Patient/Caregiver Registration / Citiva New York

Tip: Before you begin filling out this form, scan or take a picture of your medical marijuana ID card and patient certification form. If you have a temporary medical marijuana ID card, you will need a copy of the temporary card and patient certification form ready for upload.

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date of birth

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Address

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city

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state

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WHat type of card do you currently have?

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Have you previously purchaseda product from CITIVA?

Do you have a registered caregiver?

If you have a caregiver, please provide us with the caregiver's name at the end of this form.

How did you hear about us?

NY Registry Identification Card (Front)

Please upload a scanned image of picture of the signed patient certification from your physicianPlease upload a picture of the FRONT of your medical marijuana program registry identification card mailed to you by the NYS Department of Health.!

*Required Field

NY Registry Identification Card (BACK)

Please upload a scanned image of picture of the signed patient certification from your physicianPlease upload a picture of the BACK of your medical marijuana program registry identification card mailed to you by the NYS Department of Health.!

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NY Patient certification

Please upload a scanned image of picture of the signed patient certification from your physician

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is there any additional information you would like to share with our pharmacy team?

If You have any registered care giver type their name here.

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I accept the Citiva Terms of Service. Citiva Terms of Service: By registering for an online account, I agree to receive emails from Citiva MEDICAL regarding my account status, orders, and promotions. We do not share or sell information to third-parties. View our Privacy Policy.

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Patient Home Delivery Throughout New York

Have your Medical Cannabis ID Card and your NY Patient Certification ready to upload in order to create your account.

Complete These Steps Prior to Your First Order

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I need to meet with an in-store pharmacist

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Patient Home Delivery Throughout New York

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Complete These Steps Prior to Your First Order

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New York City Delivery Schedule

Call 845-875-8590

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Hudson Valley Delivery Schedule

Call 845-875-8590

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Citiva Brooklyn 202 Flatbush AVE, Brooklyn, NY 11217 (Across from Barclays Center®) View our updated hours Tel: 212.257.3145

info@citiva.com

Be. Hudson Valley 1147 Route 9, Wappingers Falls, NY 12590 (Across from Hudson Valley VW) View our updated hours Tel: 212.257.3145 Learn More

Be. Staten Island 338 New Dorp Lane, Staten Island, NY 10306 View our updated hours Tel: 212.257.3145 Learn More

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