Thank you for choosing Organigram as your licensed producer of medical marijuana. Before we can authorize a caregiver to be responsible for you as a substitute decision maker, you will need to complete the following application.


IMPORTANT: Please read and sign below I, the client, declare that my caregiver is fully responsible as a substitute decision maker on my behalf.


Client Information

Please ensure to enter your legal name.
Date of Birth

Caregiver Information

Please ensure to enter your legal name.
Date of Birth

IMPORTANT: Please read and sign below I, the caregiver, declare that I am fully responsible as a substitute decision maker for the client.


Client Signature

Caregiver Signature