Get Registered

We know how important your time is, which is why we make it so simple to register with our dispensary. Just fill out our 3-minute verification form below and click submit. It’s that easy. Your information will be immediately sent to our office where we will manually verify your medical recommendation, usually within five minutes.

    Your Name

    Your Email

    Your Phone

    Your Birthdate

    Your Street Address

    Your City

    Doctor's Name

    Doctor's Clinic Name

    Verification Website

    Verification Phone Number

    Recommendation Date

    Recommendation Expiration Date

    Recommendation #

    How did you hear about us? (choose one)

    ATTN: After submitting this form please email your Recommendation & CA I.D. to info@thestickyrose.com.

    Top