If you would like to fill out your patient forms ahead of time, please print the appropriate packet:
Certification & Renewals
Pain Log For those with limited or no medical records. Track your pain or other symptoms with two entries per day for two weeks (three pages).
Caregiver Attestation This form is required along with a change form when adding, removing, or changing a caregiver.
Change to Michigan Medical Marijuana Program (MMMP) Card Form
Medical Records Release Form This gives us permission to obtain your medical records. Please fill out and return to us with your doctor's FAX AND PHONE number. It may be faster to obtain your records yourself and bring them with you to your appointment. If you choose, you may fax them to (269) 382-1197, or mail them to: Michigan Holistic Health, 500 Crosstown Pkwy, Kalamazoo, MI 49008.
Reduced Fee Eligibility Information. Patients with SUPPLEMENTAL SECURITY INCOME (SSI) or FULL MEDICAID are eligible for a reduced $25 fee from the State of Michigan. This page describes what supporting documentation is required for Reduced Fee Eligibility.