Florida qualified physicians must obtain this written informed consent every time they issue a medical marijuana certification. The eight-page form walks the patient through federal Schedule I status, lack of FDA approval, addiction risk, impairment and driving, side effects and interactions, the state of efficacy research for each qualifying condition, and research use of registry data, with added parts for smokable marijuana. The signed form stays in the patient's medical record.
The qualified physician (MD or DO) explains each section personally and may not delegate obtaining consent. The patient, or the parent or legal guardian of a minor, initials each section, and the patient and physician sign and date Part D, which also has a witness line.
Explain each item and have the patient initial it: (a) federal Schedule I classification, including that the patient or caregiver must carry the registry identification card when in possession of marijuana; (b) lack of FDA approval and oversight; (c) potential for tolerance, dependence or addiction; (d) effects on coordination, motor skills and cognition, with warnings against driving or operating heavy machinery; (e) potential side effects and when to contact the physician; (f) risks, benefits and drug interactions, including withdrawal and overdose signs and pregnancy or breastfeeding. Write the qualified physician's name in each 'Dr.' blank.
The form summarizes the evidence for cancer, epilepsy, glaucoma, HIV, AIDS, post-traumatic stress disorder, ALS, Crohn's disease, Parkinson's disease, multiple sclerosis and chronic nonmalignant pain. For a condition of the same kind or class as a listed condition, or a terminal condition diagnosed by a physician other than the certifying physician, the physician gives the patient or caregiver a summary of current research and attaches it as a numbered addendum, entered on the form.
The patient acknowledges that de-identified information in the physician certification and the Medical Marijuana Use Registry may be used for research. The form explains that the Department of Health sends the Consortium for Medical Marijuana Clinical Outcomes Research a data set for each registered patient, including the qualifying medical condition and the daily dose amount and forms of marijuana certified.
Patients who are not under 18 with a terminal condition receiving smokable marijuana initial the opt-out line and move to the next part. For a minor who qualifies, the parent or guardian reviews and initials the remaining content on respiratory health, cognitive and psychosocial development, and addiction, including the higher risk of marijuana use disorder when use begins before age 18. OMMU guidance adds that this situation requires a Second Physician Concurrence Form.
When smoking is certified for a patient without a terminal condition, the patient acknowledges contaminant risks such as molds and mildews, respiratory health effects, the risks of second- and third-hand smoke to household members, the danger of smoking where oxygen is in use, and that self-dosing guidance was given if permitted. OMMU's physician FAQ notes that a physician's first smoking recommendation requires further documentation to the licensing board, uploaded through the registry or mailed.
The patient acknowledges discussing the recommended treatment, its risks, complications and expected benefits, its likelihood of success and failure, and alternatives including no treatment. The patient prints a name and signs, or a parent or legal guardian signs for a minor, with the date. The qualified physician signs and dates a statement that the information was explained to the named patient, and a witness signs and dates.
Download the current version from the source each time; forms change without notice.
Medical Marijuana Consent Form
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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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No. The form states that a qualified physician may not delegate the responsibility of obtaining written informed consent to another person. The physician explains each section, the patient or parent initials it, and the physician signs Part D confirming the information was explained to the named patient. A separate witness line is provided.
Each time the qualified physician issues a medical marijuana certification, not just at the first visit. The OMMU physician page says physicians must have the patient complete the approved consent form each time. Renewal certifications can be done by telehealth after an initial in-person exam, and each renewal is a new certification that needs its own signed consent.
No. The signed consent stays in the patient's medical record and is not filed with the Office of Medical Marijuana Use. Other documents do go through the Medical Marijuana Use Registry or by mail, such as documentation for a condition of the same kind or class as a qualifying condition and the extra documentation for a physician's first smokable recommendation.
The parent or legal guardian initials each section and signs Part D on the minor's behalf. If the minor has a diagnosed terminal condition and will receive smokable marijuana, the rest of Part B must be reviewed and initialed. OMMU guidance requires a second physician to concur with any order for a patient under 18, documented in the medical record.