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CONTACT US 1.510.540.7878
OPEN DAILY 10am-8pm
LICENSE NO: C12-18-0000041-TEMP
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East Bay Express
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Upload All Required Supporting Documents Here
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Accepted file types: jpg, png, pdf, jpeg.
Valid recommendation note and picture ID (US Driver’s License, Gov't ID or Passport)
Patient or Caregiver?
Caregivers must bring patient’s designated caregiver’s paperwork, as well as a government issued I.D. for themselves as well as the patient they represent. (Notarized copy is acceptable)"
rules of the PCC
I have read and agree to uphold the rules of the PCC
I authorize my recommending physician to verify his or her recommendation or approval for the use of medical cannabis
I declare under the Penalty of Perjury under the laws of the State of California (1) The information I provide to PCC is true and correct, and (2) I am not obtaining membership for fraudulent purposes.
Please sign your name in the above field. This will be considered your legal signature when form is submitted.
The Information on this form will be kept confidential