Pre-Register to Buy Medical Marijuana at NEA

Save time during your first visit by filling out our medical marijuana registration form.

NEA Medical Marijuana Pre-Registration Form

Signing up as an NEA medical marijuana patient gives you access to the best cannabis products and staff in the East. If you don’t have your medical card yet and are interested in seeing if you qualify, please see our definitive guide to getting your medical marijuana card in Massachusetts.

Patient Full Name*

Email*

Date of Birth*

day

month

year

Gender*

Male

Female

Address*

Street Address City State / Province / Region Postal / Zip Code Country

Phone*

Certified Physician Full Name

Certified Physician Phone Number

Does the patient have a Caregiver?

Yes

If Yes, Caregiver's Full Name

MA Marijuana for Medical Use Program ID #*

Date of MMJ Card Expiration Date (Format: 04/20/1993)*

Secondary ID Number as Used in Patient Registration (Example: MA License #)*

How did you hear about us?

MA Executive Office of Health & Human Services/Marijuana for Medical Use Program

Doctor Referral

Friend Referral

Employee Referral

Other Referral

Social Media

Google / Online

News / Media

Other

I attest that I will not engage in the diversion of cannabis. I understand that fraudulent distribution of medical cannabis is a felony punishable by up to 5 years in prison.*

Agree

I understand that my registration card only allows me to possess and use cannabis for medical purposes within Massachusetts. *

Agree

I understand that cannabis has not been analyzed or approved by the FDA, including cannabis produced by Northeast Alternatives.*

Agree

I understand there is limited information on the side effects of cannabis, including cannabis produced by Northeast Alternatives.*

Agree

I understand there may be health risks associated with using cannabis, including cannabis produced by Northeast Alternatives.*

Agree

I understand cannabis, including cannabis produced by Northeast Alternatives, should be kept away from children.*

Agree

I understand that when under the influence of cannabis that driving is prohibited under M.G.L. c. 90, s. 24, and machinery should not be operated.*

Agree

I understand that I may not distribute medical cannabis to any other individual, and must return unused, excess or contaminated product(s) purchased at Northeast Alternatives to a Northeast Alternatives dispensary for disposal.*

Agree

I agree at all times to abide by Massachusetts law in regards to my use of medical cannabis and hereby release and waive all claims against Northeast Alternatives from any and all liability related to my use of medical cannabis.*

Agree

I agree not to bring any weapons or anything that can be used as a weapon into any Northeast Alternatives facility.*

Agree

I agree not to use medical cannabis in a way that endangers the health and well-being of any person.*

Agree

I understand that Northeast Alternatives may refuse to dispense cannabis to me if, in the opinion of the dispensary agent, the public or myself may be placed at risk by doing so. In this event, I understand that my certifying physician will be notified within 24 hours.*

Agree

I authorize my information to be shared between Northeast Alternatives treatment facilities.*

Agree

Re-Enter Patient Full Name*

Adult Use Menu
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New to Cannabis
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About NEA
Contact

Monday-Saturday
9:00 AM – 9:00 PM

Sunday
9:00 AM – 9:00 PM

Northeast Alternatives Marijuana Dispensary
999 William S Canning Blvd
Fall River, MA 02721

(508) 567-6761
support@nealternatives.com
www.nealternatives.com

Please Consume Responsibly. This product may cause impairment and may be habit forming. For use only by adults 21 years of age and older. This product has not been analyzed or approved by the FDA. There is limited information on the side effects of using this product, and there may be associated health risks. Marijuana use during pregnancy and breast-feeding may pose potential harms. It is against the law to drive or operate machinery when under the influence of this product. KEEP THIS PRODUCT AWAY FROM CHILDREN. There may be health risks associated with consumption of this product. Marijuana can impair concentration, coordination, and judgement. The intoxicating effects of edible products may be delayed by 2 hours or more. In case of accidental ingestion, contact poison control hotline 1-800-222-1222. This product may be illegal outside of MA.