Applications will be accepted by appointment only at the following location:
Vital Records Unit
Stanislaus County Health Services Agency: Public Health
820 Scenic Dive
Modesto, CA 95350
Applicants can call 209-558-7191 to schedule an appointment.
Walk-in clients cannot be accommodated.
APPLICANT'S CHECKLIST:
Once an appointment is made, the following items must be brought to your appointment:
1. A completed application.
Forms can be downloaded and completed prior to your visit, or filled out before your appointment time.
2. Government issued photo identification (i.e. California State Driver’s License,
a California State ID Card, a United States Passport, a Veteran’s Administration ID Card).
3. Proof that you live in Stanislaus County, for example, the current photo IDs listed above,
a recent utility bill, or a recent rental or mortgage payment receipt.
4. Written documentation completed by your physician that states that you have been
diagnosed with a serious medical condition and that the medical use of marijuana is appropriate.
- Medical Condition Verification Forms
for Physicians
Download: English ISpanish
(Physician form to document patient's medical condition for use of medical marijuana.)
5. Cash or credit card approval for County Fee: $118.00, plus mandated state fee of $66.00 (as of 5/1/09). If you have proof of Medi-Cal benefits, such as a current Medi-Cal card, the fees are reduced by 50% ($92.00). All Fees are non-refundable.
Note: Your photo will be taken on the day you submit your application.
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