Quick Change Licensed Producer Form Here you can make adjustments to your ongoing allotments by changing and submitting your Licensed Producer information. Part 1: Patient Information First Name (required) Last Name (required) Email (required) Date of Birth (required) Health Care Number Part 2: Current LP Information & LP Changes LP(s) To Cancel & Switch How Many Current LP(s) To Change? 123 Current / Active LP 1 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Current / Active LP 2 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Current / Active LP 3 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Your New LP(s) Number of New LP(s) 123 New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes Add Another Quick Change (2) LP(s) To Cancel & Switch How Many Current LP(s) To Change? 123 Current / Active LP 1 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Current / Active LP 2 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Current / Active LP 3 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Your New LP(s) Number of New LP(s) 123 New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes Add Another Quick Change (3) LP(s) To Cancel & Switch How Many Current LP(s) To Change? 123 Current / Active LP 1 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Current / Active LP 2 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Current / Active LP 3 —Please choose an option—‌Acreage Pharms‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌Delta-9‌Emblem‌Green ReliefHexo‌MedReleaf‌Peace Naturals‌Solace Health‌Spectrum‌TilrayWeed MDOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Reason for Leaving —Please choose an option—PriceSupportSelectionEffectivenessShippingConfidenceSupply ConsistencyNo Change - Keep this LP Add Notes Your New LP(s) Number of New LP(s) 123 New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes New LP —Please choose an option—‌Aphria‌Aurora‌Broken Coast‌Canna Farms/Beacon MedicalCannimed‌MedReleaf‌Spectrum‌TilrayOther - Add Notes Below Allotment —Please choose an option—0.5g1.0g1.5g2.0g2.5g3.0g3.5g4.0g4.5g5.0g Add Notes Privacy Policy and Terms of Service Δ
