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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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Before you can place an order, please register for an online account.

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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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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.!

*Required Field

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

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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

EQUAL RATIO CBD:THC
Etain Balance
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$95.00
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About Citiva
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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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