Important

1. It is important to understand that all information requested must be provided to avoid unnecessary delays.
2. We cannot process the application unless both the applicant and the treating medical practitioner have signed the renewal application.
3. A new photograph,signed by the treating medical practitioner is required every five years.
4. Please retain a photocopy of this form for your files.

If you have any questions regarding this form,please contact Health Canada toll-free at 1-866-337-7705.

• Mrs.
• Miss.
• Ms.
• Mr.
• Print Name
• Applicants's full name:
  • last
  • first
  • middle
• Date of Birth:
  • day
  • month
  • year
• Gender:
• Address:
  • Apartment Number:
  • City:
  • Province:
  • Postal Code:
• Telephone: ()
• Fax: ()
• E-mail:
• If no street address is available,please provide lot and concession number:
  • Lot Number:
  • Concession Number:
• Mailing Address (if different from above):
  • Address or P.O.Box:
  • Apartment Number:
  • City:
  • Province:
  • Postal Code:

You are required to choose one of the following:

• I plan to purchase dried marihuana from Health Canada and request that my approval to receive dried marihuana be renewed.

IMPORTANT: If you want to purchase dried marihuana but do not currently have approval to receive the Health Canada product, you are required to complete FORM 1: Application to Obtain Dried Marihuana.

OR

• I plan to produce my own marihuana and request that my existing Personal-Use Production Licence be renewed.

IMPORTANT: If you want to produce your own marihuana and do not currently hold a valid Personal-Use Production Licence ,you are required to complete FORM C: Application for Licence to Produce Marihuana by Applicant.

OR

• I plan to have a designated person grow marihuana for me.

IMPORTANT: You are required to complete FORM D: Application for Licence to Produce Marihuana by a Designated Person even if renewing an application .

• Medical practitioner 's full name:
• Provincial medical licence number:
• STAMP (IF AVAILABLE)
  • Business Address:
  • Suite Number:
  • City:
  • Province:
  • Postal Code:
• Telephone: ()
• Fax: ()
• E-mail:

I declare that I am the treating medical practitioner of the individual making this renewal application for an Authorization to Possess under the Marihuana Medical Access Regulations and that there have been no changes to the information provided in the last declaration signed by me.

• MEDICAL PRACTITIONER'S SIGNATURE
• DATE
• PRINT NAME

I declare that I hold a valid Authorization to Possess under the Marihuana Medical Access Regulations and that there have been no changes to the information provided in my last approved application for an Authorization to Possess and, if applicable, Application to Obtain Dried Marihuana or Application for Licence to Produce Marihuana.

• APPLICANT'S SIGNATURE
• DATE
• PRINT NAME