Online Medical Cannabis Consultation Application

Step 1 of 4: Personal Details & ID

Step 1 of 425%

Start your PT33 review

First we collect contact, ID, and basic safety details. Medical questions come next.

This step takes about 3-5 minutes. You can fill the form first, then confirm the required agreements before continuing.

Full Name *

Date of Birth *

You must be at least 20 years old to apply (Thai law requirement)

Nationality *

ID / Passport Number *

Email Address *

Weight (kg) *

Height (cm) *

Preferred Communication Method *

Confirm these before moving to medical questions.

I agree to the Privacy Policy and consent to processing my personal and medical details for this consultation.

I agree to the Terms of Use for this telemedicine service.

Upload ID or Passport

Click to upload or drag and drop

PDF, JPG, PNG (max 5MB)

Optional KYC photo with passport

Hold your passport or ID next to your face.

This is optional, but it can help the clinic verify your identity faster. JPG, PNG, or WEBP (max 5MB).

Electronic Signature *

By typing your name, you agree to use it as your electronic signature

Medical Disclaimer & Treatment Consent *

Consultation

Start the eligibility, symptom, document, and PT33 prescription flow before a partner handoff.

Patient details

Location and partner route

Primary symptoms

Documents and payment