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NH Cannabis Written Certification Extension

New Hampshire lets the provider who signed a patient's current Written Certification lengthen it with this one-page form, so the patient keeps their registry card without a new application or fee. The total certification period, including every extension, cannot exceed 3 years, and a requested extension past that cap defaults to the maximum allowed.

Who completes it

Only the provider who signed the patient's current Written Certification completes and signs the form, giving the practice, state license number, the card's expiration date if known, and the extension length.

Submitting and payment

How to submit it
Sign it no later than the date the patient's card expires and send it to the Therapeutic Cannabis Program by mail or fax; the Program must receive it within 30 days after the card expires.
Who pays
No application fee is charged for an extension, unlike a new Patient Application.

Good to know

  • Extension lengths offered are one year, the maximum allowed, or another stated duration, and the form can be used more than once within the 3-year total.
  • Timing matters: the provider's signature must be dated on or before the card's expiration date, even though the Program accepts receipt up to 30 days afterward.
  • The Program allows no exceptions: if a requirement is missed, the patient renews with a new Written Certification, a new Patient Application and the application fee.
  • The form applies only to certifications issued for less than 3 years. Version 10/25 is posted with the Program's other provider forms.

Get the official form

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

Written Certification Extension

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

Can a different provider extend a New Hampshire cannabis certification?

No. The extension must be signed by the same provider who signed the patient's current Written Certification. Another provider would need to issue a new Written Certification, and the patient would file a new Patient Application with the fee. The total period, counting the original certification and any extensions, cannot exceed 3 years.

What is the deadline for a written certification extension?

The provider must sign and date the extension no later than the expiration date of the patient's registry card, and the Therapeutic Cannabis Program must receive it within 30 days after the card expires. Send it by mail or fax. An extension can be used more than once, as long as the total stays within 3 years.

What if the extension requirements are missed?

The Program states there are no exceptions. If the form is not signed by the original certifying provider, is signed after the card expires, or arrives more than 30 days after expiration, the patient must renew with a new Written Certification, a new Patient Application and the application fee.