Please Note: Due to high volume our registration process can take a minimum of 7 business days to complete. 


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 - 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:

• A signed Medical Document

Mail original documents,
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.




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Contact Us

Questions? Comments? Contact us using the form below:


You can also contact us by telephone at 1-888-486-7579, or by email at

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

Mailing Address: Box 1150
Ladysmith, BC, V9G1A8


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