Patient Information

To become a member you will need to do the following:

Print and complete these forms
(photo ID verification will be required)

  1. Application for Membership (Easy to fill out form)
  2. Medical Document (Original copy required for membership) – To be completed by your health care practitioner.
  3. Code of Conduct Form – Kelz adheres to a strict code of conduct to better serve our patients.

Optional Forms

  1. Letter to Doctor – You can give this to your doctor with your above form.
  2. Practitioner Release Form – If needed, this form can be filled out by yourself to reduce your practitioner’s liability in regards to your use of medical marijuana.
  3. Medical Information Release Form – If needed, this form empowers your health care provider to send us your confirmation of diagnosis.
  4. Caregiver Application Form – This form is for those with a caregiver that manages your medications.
Medical marijuana plant


Mail Order Applicants (Additional Information & Requirements)
Provide a legible copy of government issued photo ID.

Send a copy of your forms and ID to:
FAX: 306.359.MEDZ (6339) or EMAIL: or
MAIL: Kelz #140-2410 Dewdney Ave, Regina, SK S4R 1H6

Please allow 1-2 weeks for processing once we receive your application.

Some of the many things that medical marijuana can treat

  • ADHD
  • Anxiety/Stress Disorder
  • Arthritis
  • Asthma
  • Auto Accident(s)
  • Brain/Neck/Head Injury
  • Bipolar Disorder
  • Cancer
  • Cerebral Palsy
  • Chemotherapy Treatment
  • Chronic Pain
  • Colitis
  • Crohn’s Disease
  • Depression
  • Eating Disorders
  • Eczema
  • Emphysema
  • End of life/Palliative Care
  • Epilepsy
  • Fibromyalgia
  • Gastrointestinal Problems
  • Glaucoma
  • Hepatitis C
  • Insomnia
  • Irritable Bowl Syndrome
  • Kidney failure/Dialysis
  • Lyme Disease
  • Migraines
  • Multiple Sclerosis
  • Muscle Spasms
  • Muscular Dystrophy
  • Nausea
  • Neuralgia
  • Obsessive Compulsive
  • Disorder
  • Paraplegia/Quadriplegia
  • Psoriasis
  • Parkinson’s Disease
  • Post Traumatic Stress
  • Disorder
  • Radiation Therapy
  • Spinal Cord Injury
  • Substance
  • Addiction/Withdrawal
  • Muscular Dystrophy
  • Seizure Disorders
  • Sleep Disorders