1Forms_Step_12Forms_Step_23Step 31/3Forms_Step_1Step-1: Fill the Application form Next Please provide the information about you California - CA Upload your DL (front side) Upload your Selfie BackNext Step-2: Medical symptoms What is/are the main medical problem(s) which you currently have or have had in the past? HIV/AIDSNauseaFibromyalgiaSeizuresArthritisMuscle SpasmMigraine HeadachesAnxietyChronic PainGlaucomaCancerTrouble SleepingLoss of AppetiteWeight LossOther Are you RENEWING your recommendation (Have you had a recommendation in the last 10 years)? NOYES Do you currently use specific medications for your medical condition? NOYES Are you taking any prescription medications or herbs? NOYES Do you have any allergies to any medications? NOYES Have you ever had any surgeries or been hospitalized? NOYES Do you exercise? NOYES Do you smoke tobacco? NOYES Do you drink alcohol? NOYES Are there health/medical problems that occur frequently in your family? NOYES Have you experienced or been diagnosed with any of the following DepressionBipolar DisorderSchizophreniaSuicidal thoughtsADHDNone Back