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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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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.!

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

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New York City Delivery Schedule

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Citiva Brooklyn 202 Flatbush AVE, Brooklyn, NY 11217 (Across from Barclays Center®) Hours: Open Daily 10AM - 7PM Tel: 212.257.3145

Citiva Hudson Valley 1147 Route 9, Wappingers Falls, NY 12590 (Across from Hudson Valley VW) Hours: Open Daily 10AM - 7PM Tel: 212.257.3145

Email us: info@citiva.com

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