Sign Up with Broken Coast
To create an account simply fill out your information on this page. An account will allow you to view full product details.
Download the Medical Document HERE. This document must be signed by your health care practitioner.
Complete one of the following
Standard Registration Form (Online)- Applicants with a permanent address who are applying for themselves
Expanded Registration Form (Online) - Applicants who have: No permanent address, have a caregiver, or are having their marijuana shipped to their doctor.
Questions? Comments? Contact us using the form below:
You can also contact us by telephone at 1-888-486-7579, or by email at firstname.lastname@example.org.
Our office hours are from 8 a.m. to 4 p.m. PST, Monday to Friday.
Our office will be closed on Monday, December 25th & Tuesday, December 26th for the Christmas Holidays & January 1st for New Years Day.
Box 1150 Ladysmith, BC, V9G 1A8