Important Forms

STANDARD CLIENT REGISTRATION (online) - Quick, paperless, sign online.

AMENDMENT FORM (online) - Quick, paperless, sign online.

MEDICAL DOCUMENT (PDF) - To be filled out by your health care practitioner


Expanded Client Registration Form:

EXPANDED CLIENT REGISTRATION (online) - For clients who have: No permanent address, have a caregiver, or are having their marijuana shipped to their doctor.

Downloadable Registration Forms:

  • FORM A (PDF) - Applicants with a permanent address.
  • FORM B (PDF) - Applicants who do not have a permanent address (Applicant currently resides in a shelter, hostel, or similar institution.)
  • FORM C (PDF) - Applicants with a permanent residential address and (a) responsible individual(s) and/or (b) who are having their product shipped to their health care practitioner.

Paper forms can be sent to Broken Coast at: Box 1150, Ladysmith, BC, V9G1A8
*Please mail via Canada Post. Couriers such as FedEx and UPS cannot deliver to PO boxes.

Downloadable Amendment Forms

Paper forms can be sent to Broken Coast at: Box 1150, Ladysmith, BC, V9G1A8
*Please mail via Canada Post. Couriers such as FedEx and UPS cannot deliver to PO boxes.

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.

Our office will be closed on Monday, December 25th & Tuesday, December 26th for the Christmas Holidays & January 1st for New Years Day. 

Mailing Address:

Box 1150 Ladysmith, BC, V9G 1A8

 

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