First time patients who visit our dispensary will need to provide the information requested on this form. The form only needs to be completed once.
We suggest submitting the form in advance of your arrival to avoid any delays. The information you provide is validated confidentially with the Hawaii DOH Medical Cannabis Patient Registry. We will never share your private information.
Please fill in all information EXACTLY as it appears on your medical marijuana card.
After successful validation, you will receive a confirmation number by email or text. If the information you provided is incomplete, misspelled, or we are otherwise unable to validate the information, a Noa representative will contact you by email or text.
Please allow no less than 24 hours for us to process and validate your pre-registration. Please be sure to provide your confirmation number, which will be sent to you via email or text, at dispensary check-in.
STEP 1: MMJ REGISTRATION CARD INFORMATION
Please enter your mmj registration card information below. Be sure and type in the information EXACTLY as it appears on your 329 card.
STEP 2: BASIC INFORMATION
REGISTERED CAREGIVER (if applicable)
A registered caregiver is an individual selected by a patient and registered with the Department of Health to act as their agent in obtaining medication for them at the dispensary.
The following two questions are optional but will help us in determining products to offer.
WHAT IS YOUR PREFERRED METHOD OF CONSUMING CANNABIS?
WHAT PRODUCTS ARE YOU INTERESTED IN PURCHASING?
STEP 3: ACKNOWLEDGMENTS
Please read and respond to each acknowledgment below. (Required)
ALL QUESTIONS MUST BE ANSWERED YES IN ORDER TO PROCESS.
By signing this form, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. I understand that signing this page constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of the information provided in this document.