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Form B2
Medical Practitioner’s Form for Category 2 Applicants
This form is to be completed for Category 2 applicants by the applicant’s medical practitioner. Under the Marihuana Medical Access Regulations, a “medical practitioner” is a person who is authorized under the laws of a province to practice medicine in that province and who is not named in a notice given under sections 58 or 59 of the Narcotic Control Regulations.

Important

1. It is important to understand that all information requested must be provided to avoid unnecessary delays. 2. We cannot process the application until all appropriate forms are received. 3. Please retain a photocopy of this form for your files. If you have any questions regarding this form, please contact Health Canada toll-free at 1-866-337-7705.

Please forward all completed applications to:
Marihuana Medical Access Division Drug Strategy and Controlled Substances Programme Health Canada Address Locator: 3503B Ottawa, ON K1A 1B9

Note: It is within the professional purview of the medical practitioner to decide to support an application to access marihuana for medical purposes. A medical practitioner is not obliged to sign in support of an application.

Revised April 2007

B2-1

Information on Medical Practitioner

Medical practitioner’s full name: .................................................................................................................................................................................................................................................. Provincial medical licence number: .................................................................................................................................................................................................................................................. STAMP (IF AVAILABLE)

Medical specialization (if applicable):...
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