Nevada – New Patient Form

    Welcome to Cohen Medical Centers!
    In order to submit an application to the Nevada Medical Marijuana Program
    (NMMP) you must have valid State of Nevada identification, either driver’s license
    or ID card, to register for an online account and apply to the NMMP. If you are
    renewing your registration your MMP ID card is not a valid form of identification.
    The information you proved along with your email will be used to create your
    account and allow you to manage the application process. You will need to
    provide your SS# in order to complete the process.

    Security note: This document, Register as A Cardholder, will be included with your
    exit package and will not be data entered, copied, printed or saved by CMC in
    any way.

    If you already have a portal account, please skip to below the dotted line to
    provide the password information with your identification.

    CARDHOLDER EMAIL ADDRESS
    CARDHOLDER SS#
    CARDHOLDER PHONE NUMBER
    DO YOU HAVE A CAREGIVER

    *STOP HERE IF ADDRESS ON YOUR ID IS CORRECT*
    ONLY if you have a mailing address on file at the DMV please provide it below.
    NAME
    ADDRESS
    CITY
    STATE
    ZIP

    --------------- DO NOT WRITE BELOW THIS LINE ---------------
    Using your identification, an account has been created for you online with the
    Nevada portal. Please use the information below to login and access your profile.
    1. HTTPS://MMPORTAL.NV.GOV/ACCOUNT/LOGIN
    2. YOUR USERNAME WILL BE________________________________________
    3. PASSWORD WILL BE________________________________
    4. LOG ON CHANGE YOUR PASSWORD AND PRINT APPROVAL LETTER