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Alaska Medical Marijuana Registry Physician Statement

Alaska's Medical Marijuana Registry requires a signed physician statement with every application for a registry identification card. The physician gives the date they personally examined the applicant within a bona fide physician-patient relationship, states that the applicant has a debilitating medical condition under AS 17.37.070, and concludes, after considering other available and tolerable treatments, that the patient might benefit from medical use of marijuana.

Who completes it

A physician licensed in Alaska, or a U.S. armed forces or Public Health Service medical officer on duty or volunteering unpaid at an Alaska facility, signs the statement with their license number. The applicant, caregivers and witnesses complete the other pages of the packet.

Submitting and payment

How to submit it
The applicant mails the original signed statement, not a photocopy, with the registry application, ID copies and fee to Health Analytics and Vital Records; a certified copy of the documentation is also accepted.
Who pays
The patient pays the state's nonrefundable registry fee, which is lower for a renewal filed before the current card expires.

Good to know

  • Instead of the form, the physician may sign a letter addressing the same points: the personal exam and its date, the qualifying diagnosis and the consideration of other treatments.
  • The registry will not enroll a patient unless the statement shows a personal exam within the 16 months before the application, and the same test applies at each annual resubmission.
  • For a minor, the parent or guardian states that the physician explained the possible risks and benefits, and must also register as the minor's primary caregiver.
  • Qualifying conditions are cancer, glaucoma, HIV/AIDS, and chronic or debilitating diseases producing cachexia, severe pain, severe nausea, seizures or persistent muscle spasms, such as those of multiple sclerosis.

Get the official form

Download the current version from the source each time; forms change without notice.

Physician Statement for Medical Use of Marijuana Registry Applicant

Official pagePDF

How this list is checked

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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Frequently asked questions

How often does an Alaska registry patient need a new physician statement?

Every year. To keep the card in effect, the patient must annually resubmit updated documentation, including a new statement signed by the physician. The department will cancel or not renew a registration if the statement does not show a personal exam within the preceding 16 months.

Can a physician write a letter instead of the Alaska physician statement form?

Yes. The application accepts either the physician statement form or a signed letter addressing the same points: that the physician personally examined the patient in a bona fide relationship on a stated date, that the patient has a qualifying condition, and that the patient might benefit after other treatments were considered.

What happens if an Alaska registry application is incomplete?

The registry denies incomplete applications, and the applicant cannot reapply for six months. A photocopied physician statement is not accepted, so the patient needs the original signed statement or a certified copy of the documentation before mailing the packet.