Use Agreement Page For a Change Application

You are about to access a system within the Arizona Department of Health Services (ADHS) computer network. Use of this system constitutes users' consent to permit ADHS monitoring of users' activities. Evidence of unauthorized activities obtained during monitoring can and will be used by ADHS for criminal prosecution as permitted by law.

Please note that local jurisdictions may impose additional fees and/or requirements for home cultivation. Please check with your local jurisdiction for any additional information.

Please note that if you are a patient making a change to your application and you choose to designate a caregiver to cultivate for you, you as a patient cannot also cultivate. Once you have designated a caregiver, the caregiver application process must also be completed. The designated caregiver application can be completed at: http://www.azdhs.gov/medicalmarijuana/caregivers/index.htm. Please take special note of caregiver-specific application instructions. 

To successfully complete and submit an application, users must:

  •   Download Adobe Reader. Without it, you will not be able to print a copy of your application.
  •   Enter your current card identification number and first and last name.
  •   Have ready an electronic copy of your identification for a change to a designated caregiver's card.
  •   Have ready an electronic copy of your identification for a change to a qualifying patient's card.
  •   Have ready the Qualifying Patient Request to Add or Replace Caregiver Form if a qualifying patient is making a change to
      add,replace,or remove a caregiver.
  •   Have ready a Visa or Mastercard for payment.
  •   Verify all data are correct before saving each page of the application.
  •   Complete and submit the entire application without closing the browser. You will not be able to save and resume your
      application later.

For your own protection and confidentiality, the system will not display saved information once a page is exited.

By submitting this application I am acknowledging that I am aware that:

The sale, manufacture, distribution, use, possession, etc., of marijuana is illegal under federal law. A registry identification card or registration certificate issued by the Arizona Department of Health Services pursuant to Arizona Revised Statutes Title 36, Chapter 28.1 and Arizona Administrative Code Title 9, Chapter 17 does not protect me from legal action by federal authorities, including possible criminal prosecution for violations of federal law.

I understand that while I may lawfully purchase, possess and use (for qualifying patients only) “medical” marijuana under state law, it is lawful only if done in strict compliance with the requirements of the Arizona Medical Marijuana Act (“Act”), Arizona Revised Statutes Title 36, Chapter 28.1 and Arizona Administrative Code Title 9, Chapter 17. Any failure to comply with the Arizona Medical Marijuana Act ("Act"), Arizona Revised Statutes Title 36, Chapter 28.1 and Arizona Administrative Code Title 9, Chapter 17 may result in the revocation of the registry identification card or registration certificate issued by the Arizona Department of Health Services, and possible arrest, prosecution, imprisonment and fines for violation of state drug laws. I understand that it is my responsibility to fully understand and comply with the Arizona Medical Marijuana Act ("Act"), Arizona Revised Statutes Title 36, Chapter 28.1 and Arizona Administrative Code Title 9, Chapter 17.

You must close your browser window and start a new browser window after each application. If you do not follow this requirement unpredictable results may occur and you may lose the fee that you paid.

Do not click your browser's back button.

Access Denied

Since you chose to not accept the use agreement you are not allowed access to the Arizona Department of Health Services (ADHS) computer network.

Please close your browser window.


Access Denied

Since you chose to not accept the use agreement you are not allowed access to the Arizona Department of Health Services (ADHS) computer network.

Please close your browser window.

Arizona Department of Health Services

Change Application Search :

                                                                                            Go back to choose different application type
                                                                                                   Click here to go back and choose different application type.
Change Application Information