Steps to Certification
The following are the Steps to Certification:
1. Proof of Massachusetts Residency:
- Driver’s license OR
- Massachusetts State ID OR
- Passport with proof of residency i.e. utility bill, lease, etc. in your name
2. Medical Records
Medical Records should be from a physician(s) or therapist(s) and state a debilitating condition that is active and for which you are receiving treatment. Records should be from within the past two years.
Here is a Medical Release Form to provide to your phyician to obtain records directly or have them faxed to us at 413-391-7489.
- Office visit notes re: diagnosis/treatment (within past two years) OR
- Current Active Problem List (date specific) OR
- Letter from treating physician attesting to ongoing treatment for specified condition.
- Medication lists/notes/sheets (optional).
We do not accept:
- Any records older than two years.
- MRI’s/X-Rays/CT scans/EKG’s.
- Blood/Lab work.
- Surgical Reports.
- Hospital visit records.
- School Reports.
- Insurance Claims.
- Medical bills.
3. Medical History Intake Form:
Print and fill out this Medical History Intake Form and bring it to your scheduled appointment (or arrive 15 minutes early to complete).
4. Call MariMed Consults at 413-455-1081 to schedule an appointment. We look forward to seeing you.
Northgate Professional Center, 1985 Main Street, Suite 209, Springfield, MA 01103