A complete application must include all of the following:
A signed and completed application form – Please make sure all fields are filled in and completed with accuracy. Don’t forget to sign and date your application!
- Patient / caregiver application form (DPH IL form – pdf): – Click here
Proof of residency – You will need two items that prove you live in Illinois. We recommend using your driver’s license and a utility bill. However, bank statements, state ID’s and voter ID cards would all be acceptable. All ID cards must be color copies, not black and white. The addresses on each of the documents must match the address on your application. Check the application for a full list of accepted forms of proof of residency.
Proof of age and identity of the qualifying patient – A color copy of a valid, unexpired government issued photo ID. (Example: Driver’s license, State ID Card, Passport. School or University IDs are NOT acceptable)
2×2 Color photograph of the qualifying patient – We recommend that patients have a passport photograph taken. This can be done locally at places like CVS, Walgreens, Wal-Mart and some Post Office locations. The photograph must be a color 2×2 inch passport-sized photo. Double check – are you by yourself, facing the camera, is your full-face showing? DO NOT SEND IN SELFIES OR VACATION PHOTOS. It might sound silly, but the Department of Public Health has received some interesting photos that do not meet the requirements.
Physician Certification Form or appropriate documentation for veterans – It is important to note that patients are not actually receiving a prescription for medical cannabis; rather, patients are receiving a CERTIFICATION for cannabis.
Physicians are required to complete this certification form and mail it directly to the Department of Public Health; this cannot be done by the patient. Veterans who are receiving medical care at a U.S. Department of Veterans Affairs facility do not require a written certification from a doctor, they will simply need documentation from the VA proving they are suffering with one or more of the approved qualifying conditions. We urge patients to provide your doctor with a copy of this form as well as a pre-addressed and stamped envelope. Patients who are diagnosed with a terminal illness have an expedited application process with a separate form.
Designated caregiver information (optional). – This form is only required if the patient will be utilizing a caregiver. A caregiver is a person who will be authorized to purchase, handle and administer medical cannabis for a patient who is unable to do so themselves. Caregivers are not allowed to use medical cannabis.
Caregivers must go through a similar process as the patient. They are required to complete the entire caregiver application and send it with the $75 caregiver fee and all supporting documents (photo, proof of residency, proof of age and identity, fingerprint consent form, caregiver’s signature). The caregiver application should be sent with your patient application.
Copy of the fingerprint consent form – All patients are required to complete and pass a fingerprint-based criminal background check free of any excluded offenses. An excluded offense would include a felony under the Illinois Controlled Substances Act, Cannabis Control Act, or Methamphetamine Control and Community Protection Act, or similar provisions in a local ordinance or other jurisdiction. If you believe the excluded offense is not justifiable then you may submit an “Excluded Offense Waiver.”
A list of fingerprint vendors can be found here. The form must be signed and include the Transaction Control Number (TCN). You must submit the completed form along with your application within 10 days of being finger printed. Because the fingerprints are time sensitive, we recommend you do this after your physician has already submitted their recommendation. You must submit this form within 10 days of being fingerprinted!
Selection of medical cannabis dispensary – To geographically disperse 60 dispensaries throughout the State, they have been divided up by Illinois State Police Districts. Herbal Remedies is located in District 20. Patients must select which district they plan to shop in when they submit their application. Patients are not required to shop within the district that they live in. For example, some patients might live in District 14 but would elect to shop at the dispensary in District 20 because they are geographically closer to that dispensary. Patients are free to change their elected dispensary at any time, but the process can be tedious and we urge patients to switch only if it will dramatically improve their situation.
- ISP Districts 1, 6, 7, 12, 13, 14, 17, 18, 19, 20, 21 and 22 shall be allocated one dispensary each. (Herbal Remedies is located in District 20)
- ISP Districts 8, 9, 10, 11 and 16 shall be allocated two dispensaries each.
- Within Chicago metro area but outside of Cook County shall be allocated 14 dispensaries.
- The part of Cook County outside of the City of Chicago shall be allocated 11 dispensaries.
- The City of Chicago shall be allocated 13 dispensaries.
Application fee – A non-refundable fee of $300 or reduced fee of $150 for veterans or persons enrolled in federal Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) disability program must be included with your application. Veterans, include a copy of your DD214. SSDI/SSI recipients, include a copy of your benefit verification letter, dated within the last year.
Applications can be submitted electronically by using the eLicense System provided by the Department of Public Health: https://medicalcannabispatients.illinois.gov/
Or, if you are mailing in a physical copy of your application and its supporting documents, please send it to:
Illinois Department of Public Health
Division of Medical Cannabis
535 West Jefferson Street
Springfield, Illinois 62761-0001
The eLicense System provided by the Department of Public Health seems to be slightly faster than mailing in a physical copy of your supporting documents. Patients who are in a hurry to receive their recommendation should use the eLicense system rather than resorting to snail mail.
If you would still prefer to mail in a physical copy of your application you may print out the required forms below:
- Patient Application Form
- Terminal Illness Application Form
- Caregiver Application Form
- Physician Certification Form
(must be completed and mailed to DPH by your doctor)
- To find a Live Scan Fingerprint Vendor in your area please refer to this list.
- Application for Registry Identification Card for Qualifying Patients Under 18 Years of Age and their Designated Caregivers
- Reviewing Physician Written Certification Form for Qualifying Patients Under 18 Years of Age
If you or someone you know has questions about the application process or becoming a patient, please don’t hesitate to contact us; we are happy to help!