Updated 07/01/2026 · no notarization required

Georgia Medical Cannabis Physician Certification — online

This is the Georgia Department of Public Health certification form, digitized. Fill in your patient and caregiver sections here; Dr. Hodge completes and signs the physician section at your consult. Nothing needs to be printed or notarized.

1Form→
2Payment at consult→
3Schedule

After you submit, you'll book your 15-minute consult right here. Payment ($149.99, or $124.99 with PLANTS25) is collected at the visit.

Patient information

Names must match your government-issued photo ID.

Patient's first name *

Patient's last name *

Date of birth

Telephone *

Address (street, city, state, ZIP)

Email address *

Caregiver information

Optional. A caregiver is a parent/guardian of a patient under 18, an adult you designate to help you purchase and administer medical cannabis, or a health care institution.

Treatment & residency

2. Will your physician continue treating you following the use of medical cannabis?

3. Do you currently reside in the State of Georgia?

4. How long has this physician been treating you?

5. How long have you been diagnosed with the condition(s) above?

6. What other treatments have you received or are you receiving?

7. Comments (optional)

Signature

No notary needed — the July 2026 form removed that requirement.

Type your full legal name as your signature *

I confirm the information above is true and accurate to the best of my knowledge, and I authorize Dr. Rasean Hodge, MD to use it to complete and submit my Georgia Department of Public Health medical cannabis physician certification. I understand this form is not a prescription and that certification is at the physician's medical discretion.

Sent securely to Dr. Hodge's office. See our HIPAA notice and privacy policy.

Georgia Medical Cannabis Physician Certification — online

Patient information

Caregiver information

1. Diagnosed condition(s) under treatment

Treatment & residency

Signature