BPG MEMBERSHIP APPLICATION

You must become a member of our collective before you can access our products and services. To apply for membership, please complete our membership application and provide us with scanned copies of your physician's recommendation and government-issued ID.

If you are applying as a Primary Caregiver, you must also complete and submit a Designation of Primary Caregiver From. (DOWNLOAD PDF)

Some applications may require additional proof of California residency. Please bring all required application documentation to your first in-store visit to BPG.

Please email any membership questions to: membership@myBPG.com

APPLICANT INFORMATION

(Berkeley Patients Group will provide services in a nondiscriminatory manner and make a public declaration of commitment to nondiscriminatory behavior.)
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Please use this upload button to attach images or scans of all the required supporting documents to your application. You may add multiple files to this container by clicking Upload and then selecting the multiple files while pressing the CTRL button (PC) or Command Button (Mac). Once all files are selected and submitted, the files will automatically upload in the background.

Don’t forget to include images or scans of the following items:

  • Current letter of recommendation from a California-licensed physician
  • Valid government-issued photo ID
  • Signed copy of the Designation of Primary Caregiver Form (DOWNLOAD PDF) - REQUIRED FOR PRIMARY CAREGIVERS ONLY

Please Note: We only accept JPEG and PDF file types. Individual file size cannot exceed 5 MB.

Are you a patient or a caregiver?

PHYSICIAN INFORMATION

Upon signing this document, the Applicant gives permission to the physician named above to verify his/her recommendation for the use of medical cannabis (marijuana) to BPG.

CAREGIVER INFORMATION

Please download and complete this form and submit as an upload with your online application.

MEMBER RULES

(ALL applicants must complete this section.)
View the BPG MEMBER RULES here
Rules

By signing this document I affirm that all the information provided above, and the supporting documents provided, are true and correct. I choose BPG to care for my safety and wellbeing, and to provide medical cannabis for treatment as recommended by my physician per California Health and Safety Code 11362.5.

You are consenting to the submission of this form via electronic means. Your typed name above will be considered your legal and undisputed signature.

The information provided on this form will be kept confidential and will be used strictly for internal administrative purposes, research and, unless otherwise opted out, marketing purposes. No identifying information (name, address, government-issued ID number or contact information) will be released without written permission from the applicant. For questions regarding the use of this information, please contact us at membership@myBPG.com