Move to Numed

Which NuMed Dispensary Would You Like to Switch To?*
Are We Your First Dispensary, or Are You Switching?*
Your Patient Registry Identification Number*
We'll need the identification number from your valid Illinois medical cannabis card; this is an 8-digit number that begins with "QP."
Your Name:*
First Last
Your Date of Birth:*
Date Format: MM slash DD slash YYYY
Your Email:
Your Phone:*
Address*
Street Address City ZIP Code
Permission to Submit Your Form to IDPH*
NuMed will submit your information to the Department of Public Health. Please note: it may take the state up to 48 hours to process your request.
- I agree to allow NuMed to submit this form to IDPH on my behalf.