Please complete the information below to get registered as a legal medical marijuana patient caregiver today. Caregiver Registration - Information Must Match Your Florida Drivers License Last Name * First Name * Middle Name or Initial (If applicable) Phone * Email (Must Be Different Than The Email We're Using For Patient) * Date of Birth * Gender MaleFemale Social Security Number * Florida Drivers License Number * Address * City * State * Zip Code * County * Patients Name * * Required
