New Patient Registration Form

Patients are asked to complete the ‘New Patient Registration Form’ prior to their consultation with Dr. Kulik. A list of documents our office requires is listed on page two of the form. Patients should return the registration form along with any accompanying documents to

Following our office receiving the patient’s forms, the patient will be scheduled for a consultation with Dr. Kulik. If Dr. Kulik certifies the patient for the Medical Marijuana Program, the patient will be issued a certification number. The certification number will be required for the patient to register as medically certified for the Medical Marijuana Program of New York or New Jersey.

Patients may click the download button below and are able to enter their information directly into the New Patient Form.


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