Patient Registration

Please fill out required fields to sign up for Los Ganjales Collective Delivery service. Start ordering medical marijuana safely, discreetly, and right away.

I accept the terms and conditions of Los Ganjales' Collective Membership Agreement

Your Email (required)

First Name (required)

Last Name (required)

Driver's License Number (required)

Date of Birth (required)

Street Address, including Apt/Unit # (required)

City (required)

Zip Code (required)

Phone Number (required)

Doctor's Name (required)

Doctor's Verification Website (required)

Doctor's Phone Number (required)

Recommendation (Chart) ID Number (required)

Date Recommendation Expires (required)

Upload Doctor's Recommendation (required)

Upload ID or Driver License (required)