M | W | F | Sat 12 - 7 | Thurs. 11 - 7 | 1335 Lakeside Dr., Romeoville, IL 60446 630-359-3213

Illinois Medical Marijuana Dispensary Selection Form

Illinois Medical Marijuana  Dispensary Selection FormWhether you are a newly approved medical cannabis patient in Illinois or you have been visiting another nearby medical cannabis dispensary in Will, Dupage, Kane or Cook County, the time has come that you can select MCC Dispensary as your chosen medical cannabis dispensary.

Patients can either use the hard copy form found at the link below or patients can access our online form at the bottom of this page to select an Illinois dispensary.

Illinois Medical Cannabis Dispensary Selection Form

Once completed, patients can email the form to [email protected], or Fax the form to 217-782-1321, or mail the form to:

Illinois Department of Public Health
Division of Medical Cannabis
535 W. Jefferson Street; MC-002
Springfield, IL 62761-0001

For those patients who would like Midwest Compassion Center to submit the form on their behalf please complete the fields below and submit this information to our staff and we will complete your form and email it to the Department of Health.

If you have any questions please contact MCC Dispensary via email or by phone at 630-359-3213.

Illinois Medical Marijuana Dispensary Selection Online Form

Your Name (required)

Date of Birth (required)

Patient Registry Identification Number (required)

Your Email (required)

Phone Number (required)

Address (required)

City, State, and Zip Code (required)

By checking this box I agree to allow Midwest Compassion Center to submit the Dispensary Selection Form on my behalf.

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