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Apollo Cannabis Clinics Booking Request Form

Complete this form if you are looking to book an appointment with Apollo Cannabis Clinics and claim medical cannabis under your HCSA or group benefits plan at Manulife. Upon completion of this form, you will be contacted to book an appointment to speak with a healthcare practitioner at Apollo.

 

Staff Appt Request Form

"*" indicates required fields

Are you currently a patient of Apollo Cannabis Clinics?*
Name (As shown on your healthcard)*
Do you consent with Apollo Clinics communicating with you by email?*
Is this a home or mobile phone number?*
Best Time to Call?*
Ensure you carefully review the address information before submitting this form.
Are you a veteran of the Canadian Armed Forces?*
Have you been in a Motor Vehicle Accident (MVA) AND currently have an open claim?*
Have you previously been diagnosed with schizophrenia, bipolar disorder or another mood disorder?*

Will you be claiming medical cannabis using your drug benefit coverage or will you use your Health Care Spending Account?*
Note: If you are going to claim medical cannabis under your drug benefit coverage Apollo Clinics will send you a copy of your medical document/prescription which is required for Manulife to process your claim. You will be provided more information after your appointment with Apollo on how to claim your medical cannabis.
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