Verified Florida Patient Application | Green Street Vapor Co.

Patient Verification Process

STEP 1: REGISTER AN ACCOUNT — HERE. (IF YOU DON’T HAVE A USER ACCOUNT, WE CANT SET YOU AS A PATIENT.)

STEP 2: ONLY AFTER you finish Step 1…….THEN fill out, and submit the patient verification form below.

STEP 3: Attach a photo or scan of your patient I.D. (Please cover all personal information EXCEPT your Name, and Photo)

STEP 4: Submit your patient application.

Name
First Last
Email
D.O.B.
Date Format: MM slash DD slash YYYY
Patient I.D.*
Accepted file types: jpg, png, pdf, jpeg.
Please upload an image of your Registry Identification Card with your name visible. **For your safety, please block out any sensitive information.
Email Opt In
- Email Opt In
*Check above to opt in to receive notifications, special offers, and special invitations from Green Street Vapor. (You may opt out at any time)
Comments
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