Patient Registration New - Beehive Farmacy

Do you have a:*
- State Issued Medical Card
- QMP Issued Recommendation Letter
- Neither, I need one.
Have you met with a Pharmacist at another Pharmacy?
- Yes
- No
Your Information/Patient Registration
Please follow the steps below to expedite your check in process. If you do not know your QMP#, log into EVS and locate it under the "Patient Certification" tab.
Name*
First Last
Phone*
Email*
Birth Date*
Qualified Medical Provider*
Qualified Medical Provider License ID#*
Medical Cannabis Patient ID#*
Identification*
Government Issued ID#*
Please Upload a Photo or Copy of your driver's license*
Please Upload your Patient Card ID from the State of Utah*
Patient Registration
Please follow the steps below to expedite your check in process. Since you are using a Letter, you will be seen by our pharmacist for an initial consultation.
Name*
First Last
Email*
Phone*
Birth Date*
Gender*
Qualified Medical Provider Office*
Qualified Medical Provider’s Name*
Identification*
Government Issued ID#*
Please Upload a Photo or Copy of your driver's license*
Please Upload a photo of your Recommendation Letter*

Your Information/Patient Registration