REGISTRATION OPEN:

 

 

Sign Up with Broken Coast

Use the form on this page to create an account with us. Once you've logged in you'll be able to view more details about our products.

Signing up doesn't lock you into anything — you are under no obligation to apply to be a customer or send in application forms.

If you decide you would like to become a client, continue to step 2 below.


 

Get Authorization

Download a Medical Document from Broken Coast Cannabis HERE. This document must be filled out completely and signed by your health care practitioner.

Mail the completed document to Broken Coast Cannabis (see Step 4.)


 

Complete Application Form

Print and fill out the application form below that corresponds to your current living situation.

FORM A (Online)
FORM A (PDF) - Applicants with a permanent address who are applying for themselves

FORM B - Applicants who do not have a permanent address (Applicant currently resides in a shelter, hostel, or similar institution.)

FORM C - Applicants with a permanent address who have a caregiver or have their medicine sent to their doctor


 

Mail Forms to Broken Coast

Mail your paperwork to us. We require:

• FORM A
or FORM B
• A signed Medical Document


Mail original documents,
NOT PHOTOCOPIES
to us at:

Broken Coast Cannabis
PO Box 1150, 610, 1st Ave.
Ladysmith, BC  V9G 1A8

*Please send via Canada Post. Couriers such as FedEx and UPS cannot deliver to PO boxes.

TO VIEW FULL PRODUCT DETAILS

Contact

Login

Subscribe to our newsletter for updates from Broken Coast

Contact Us

Questions? Comments? Contact us using the form below:

Submit

You can also contact us by telephone at 1-888-486-7579, or by email at info@brokencoast.ca.

Our office hours are from 8 a.m. to 4 p.m. PST, Monday to Friday.

Mailing Address: Box 1150
Ladysmith, BC, V9G1A8

 

Sign In

Or sign up to view full strain details

Remember me on this computer | I forgot my password
    Remember me    |    I forgot my password

Reset Password

Please enter your username or email address to reset your password.

Return to Sign In