NEW YORKLOCATIONS

Patient Registration / Citiva Medical 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.

First name

*Required Field

Email ID

*Required Field

Last name

*Required Field

date of birth

*Required Field

Gender

Address

*Required Field

Apt , suite ,floor

city

*Required Field

state

zip code

*Required Field

cell phone

*Required Field

WHat type of card do you currently have?

*Required Field

Have you previously purchaseda product from CITIVA?

Do you have a registered caregiver?

How did you hear about us?

NY Registry Identification Card (Front)

*Required Field

NY Registry Identification Card (BACK)

*Required Field

NY Patient certification

*Required Field

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.

I’d like to receive promotional messages via text/SMS. Sign-up for exclusive deals. We do not share or sell information to third-parties. Text STOP to cancel any time. View our Privacy Policy.

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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VISIT OUR

NEW YORK
LOCATIONS

NOW OPEN!BROOKLYN

NOW OPENHUDSON VALLEY

STATENISLAND

BIGFLATS

Please Send Us Your Info To Schedule a Pharmacist Meeting

Please Login to Your Account

Follow the steps in the link in order to obtain a Medical Cannabis ID Card

Before you can place an olnine order please register for anonline account.

Patient Home Delivery Throughout New York

Complete These Steps Prior to Your First Order

I need to obtain a medical cannabis ID card first

I need to meet with an in-store pharmacist

Patient Home Delivery Throughout New York

Complete These Steps Prior to Your First Order

I need to create a registered account on

I’m ready to place an Online Delivery Order

New York City Delivery Schedule

Call 845-875-8590

Hudson Valley Delivery Schedule

Call 845-875-8590

VISIT OUR

NEW YORKLOCATIONS

NOW OPEN!BROOKLYN

NOW OPENHUDSON VALLEY

STATENISLAND

BIGFLATS

Please Send Us Your Info To
Schedule a Pharmacist Meeting

NEW YORK
LOCATIONS