Start Florida Certification

I understand the following points:

  • The Federal Government classification of marijuana is a Schedule 1 controlled substance, which means, that it is still illegal under Federal law.
  • That Medical Marijuana has not been evaluated by the Food and Drug Administration.
  • The current state of research on the efficacy of marijuana to treat the qualifying condition.
  • There is potential for addiction.
  • Marijuana may have an adverse effect on your coordination, motor skills, and cognition, do not operate heavy machinery, motor vehicle, or engage in activities that require you to be alert or respond quickly.
  • That there are potential adverse side effects of marijuana use, just like any other medication.
  • There are risks, benefits, and drug interactions of marijuana.
  • I choose to use medical marijuana to treat my qualifying condition.
  • I understand that the provider is not my primary care provider/Specialist and therefore not responsible for any of my medical care or treatment. I need to address any medical conditions with another health care provider.
  • I understand that the provider will determine if I receive therapeutic or palliative benefits.
  • I understand that today I am only seeing the provider for my need to use medical marijuana.
  • I am a Florida resident.
  • I understand that I can contact the Relief Clinic at any for further questions or to meet with a provider again.
  • I agree to provide supporting documents pertaining to my medical condition(s) if requested by the medical provider.
  • I understand If I am pregnant or breastfeeding, I should not use cannabis.
  • I understand that if I need counseling that the Relief Clinic LLC will provide me information.
  • I hereby declare that I understand the above points and agree to them.

Florida Certification Form

Are you looking for medical cards The Villages, FL and residents in the surrounding areas need for medical marijuana? We can help! If you live in the state of Florida, all you have to do is fill out the form below to start the certification process. Once you fill out all of the fields and submit the form, our team at Relief Clinic LLC will be in touch with you.

If you have any questions or concerns about starting your certification form in Florida, get in touch with Relief Clinic LLC by calling us at (352) 661-1272. Our team will be happy to help you.


1 year and New Patients have to sign the form

Appointment Prepayment 

Pre-payment needed to book your appointment


PTSD/Anxiety Form

All patients with anxiety, depression and other mental health conditions must fill out this form