Secure patient form

Financial policy

Our fees are simple and paid up front. Please read each point and tick to confirm you understand it. Questions? Call Will at (218) 274‑4500.

Required

Patient

First name

Last name

Date of birth

Phone

Our clinic fees

Medical cannabis: $250 new evaluation, $230 recertification. Men's health consultation: $200, credited toward treatment if you go ahead. Peptide consultation: confirmed when we call.

Signature

Typing your full legal name here is your electronic signature.

Today's date

If you are signing for the patient, your relationship to them

For example, parent, legal guardian or personal representative.

Sent privately to our care team