Connecticut patients cannot register for the Medical Marijuana Program until a certifying prescriber starts their application. The physician, physician assistant or APRN treating the patient for a qualifying condition certifies online that the patient meets the medical prerequisites for a registration certificate, after entering a patient profile with a valid email address and primary phone number.
A Connecticut-licensed physician, PA or APRN treating the patient for the qualifying condition completes the whole electronic certification, including the patient profile. The patient and any caregiver then complete their own registration.
Download the current version from the source each time; forms change without notice.
Medical Marijuana Program Patient Certification (online registration system)
Connecticut Department of Consumer Protection, Medical Marijuana Program takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
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.
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Connecticut-licensed physicians, physician assistants and advanced practice registered nurses who are treating the patient for a qualifying condition. They log in to the online registration system through a DAS Business Network account, and no patient or caregiver can log in until the prescriber initiates the application.
The patient profile must include a valid email address and a primary phone number before the certification can be submitted. The prescriber then certifies that the patient meets the medical prerequisites for a registration certificate, and the patient completes the rest of the registration.
The patient must be a Connecticut resident treated for a qualifying condition by a Connecticut-licensed physician, PA or APRN. If the patient has none of the listed conditions, DCP says a petition can be filed with the Board of Physicians to add one.