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Meet With Our Pharmacist

Please Send Us Your Info To
Schedule a Pharmacist Meeting

GREAT NEWS!

Name: Etain Forte
SKU: etain_forte_vape
Availability: InStock

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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Thank You

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
AND REGISTER FOR AN ACCOUNT
TO GET NOTIFIED ON DELIVERY
LOCATION UPDATES.

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Get an MM ID Card
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Follow the steps in the link to obtain a New York State Medical Marijuana ID card

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.

First name

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Last name

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Email ID

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date of birth

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Address

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Apt , suite ,floor

city

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state

zip code

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cell phone

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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.!

*Required Field

NY Patient certification

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

*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.

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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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