This is only necessary for first time patients. 

Apothecary Services New Patient Application

You may print and fill out, submit online or wait for driver who will provide form upon delivery.

Please note that providing a false declaration under penalties of perjury is a criminal offense. This patient application document constitutes a sworn declaration under law and is intended to be governed by the electronic signature act. 

Email: medpotdelivery@gmail.com
Phone: 424.209.9333