Patient Registration

First-time Patients visiting ACS are requested to submit a registration form before visiting the dispensary to help expedite the check-in process.

"*" indicates required fields

Patient Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Address*

Street Address City State ZIP Code

Phone Number*

Email*

Patient Registration Number*

Found on Medical Marijuana Patient Program ID card (ex: P12345678)

Valid State ID Number or Passport ID Number*

State ID or Passport Expiration Date*

MM slash DD slash YYYY

Do you have a Registered Caregiver?*

Yes

No

Caregiver Name

First Last

Caregiver Registration Number

Found on Medical Marijuana Caregiver Program ID card (ex: C12345678)

Caregiver Registration Expiration Date

MM slash DD slash YYYY

*Found on the Massachusetts Medical Marijuana Caregiver Program ID card. Note – The Caregiver Registration expiration date may be different from the Medical Marijuana Patient Certification expiration date.

How did you hear about Alternative Compassion Services? (Choose all that apply)*

Search Engine (ex. Google)

Word of Mouth

Facebook

Instagram

Twitter

Hull Times Summer Guide

Trade Show (ex. NECANN)

Patient Referral

Other

I would like to receive special discounts, exclusive deals, and dispensary updates by subscribing to ACS emails and text messages.

Yes

Welcome
Product Menu
Contact
Policies

Bridgewater
693 Elm St.
Sat – Tues: 11 am - 5 pm
Wed - Fri: 9 am - 7 pm

Hull
175 George Washington Blvd.
Sun – Wed: 8 am – 8 pm
Thu – Sat: 8 am – 9 pm

508-356-5151

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All information displayed on this website is for educational purposes only, and is not to be construed as medical advice or treatment for any specific person or condition. Cannabis has not been analyzed or approved by the FDA. Individual results may vary. Please Consume Responsibly.

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