Transfer/Select EarthMed As Your Dispensary

Use this form to either transfer to EarthMed or select EarthMed if you are a new patient.

Name *

Date of Birth *

Patient ID (QP) Number *

E-mail *

Phone *

Address *

City, State, Zip *

Are you new or switching dispensaries? *

Fill Out the Form and We’ll Handle the rest

We can take care of the transfer and/or dispensary selection paperwork.  Simply fill out the form on this page and we will handle care of the rest. We will let you know the progress of your paperwork. Thanks for choosing EarthMed!

Step 1 – Fill Out Form

We just need a little info, and we can handle the submission to the state for you.

Step 2 – Staff Review and State Submission

Once we review your application, we send the paperwork to the state of Illinois.

Step 3 – State of Illinois Processes the Form

The state will process your form, which typically takes 24 hours.

Step 4 – State Approval

We check frequently to make sure the state approves your application. We will be on hand to help with this process.

Step 5 – Process is Complete

Once the state informs us that the process is complete, we contact you and welcome to EarthMed!