New Patient Registration

Government Issued ID Information

Medical Card ID Information


Please read the list below and initial next to each item to show you have understood and agreed to these rules and policies. I understand that in order to access the Aura of Rhode Island, Inc. (“Aura”) Compassion Center, either in person or via home delivery, I have agreed to the following:

I understand that it is my responsibility to be informed regarding the state and federal laws regarding the possession, use, sale/purchase and/or distribution of marijuana.

Diversion of medicinal marijuana (selling or giving it to any other person, whether or not they are a patient) is illegal. Aura will terminate the membership of any client who engages in behavior that indicates diversion MAY be happening, and we will report all suspicious behavior to the Department of Health, Department of Business Regulation, and to local law enforcement.

State law prohibits children under the age of 18 and other persons who are not Patients or Caregivers from accessing the facility. Please arrange for child care when you visit.

Cell phone and camera use along with video recording in the Compassion Center is strictly prohibited. If any Patient, Caregiver, or Authorized Purchaser needs to use their phone, they are expected to do so outside the dispensary.

I understand that I must show my valid Medical Marijuana Card AND a valid State Driver’s License/ID (No Phone Copy) each time I visit Aura or receive a home delivery. Caregivers/Authorized Purchasers must bring both their own documents and their Patient's
Medical Marijuana Card at the first visit. Expired forms of identification will restrict you from completing a purchase, even if an updated form was previously accepted and recorded in our systems.

Should Aura accept debit card or cashless ATM payments, the name on the debit card must match the name of the Patient, Caregiver, or Authorized Purchaser making the purchase.

Patients abandoning their completed online orders 3 times (no call no show) will be revoked of the privilege of placing online orders unless the order is pre-paid.

Home deliveries will only be made to the Rhode Island patient cardholder at their home address or to the hospice, treatment, or other medical care facility where the Patient is admitted,provided the facility permits the Patient’s possession and/or use of medical marijuana on the premises. Authorized Purchasers or Caregivers cannot receive delivery unless the Patient is present.

All marijuana is non-returnable and non-refundable unless the marijuana contains contamination or is defective. Please review your order with an associate to make sure your purchase is correct before you complete your purchase.

Marijuana use is prohibited on the property. Never use or display your medicine in the parking lot or in your vehicle.

I understand that the federal government has classified marijuana as a Schedule I controlled substance. Schedule I substances are defined, in part, as having (1) a high potential for abuse; (2) no currently accepted medical use in treatment in the United States; and (3) a lack of accepted safety for use under medical supervision. Federal law prohibits the manufacture, distribution and possession of marijuana even in states, such as Rhode Island, which have modified their state laws to treat marijuana as a medicine.

I understand that marijuana has not been approved by the Food and Drug Administration for marketing as a drug. Therefore the “manufacture” of marijuana for medical use is not subject to any standards quality control, or other oversight by the FDA. The efficacy and potency of marijuana may vary widely depending on the marijuana strain and ingestion method. Estimating the proper marijuana dosage is very important.

I understand that the use of marijuana can affect coordination, motor skills and cognition,i.e., the ability to think, judge and reason. While using marijuana, I should not drive, operate heavy machinery or engage in any activities that require me to be alert and/or respond quickly. I understand that if I drive while under the influence of marijuana, I can be arrested for “driving under the influence.” Marijuana should be treated as an open container of alcohol. It should not be within reach in the car, and should not be extinguished in the vehicle's ashtray.

Marijuana use and its interactions with other medicine is not fully understood. If I am taking medications or undergoing treatment for any medical condition, I understand that I should consult with my treating physician(s) before using marijuana and that I should not discontinue any medication or treatment previously prescribed unless advised to do so by the treating physician(s).

Potential side effects from the use of marijuana include, but are not limited to, the following: dizziness, anxiety, confusion, sedation, low blood pressure, impairment of short term memory, euphoria, difficulty in completing complex tasks, suppression of the body’s immune system, inability to concentrate, impaired motor skills, paranoia, psychotic symptoms, general apathy, depression and/or restlessness.

Smoking marijuana may cause respiratory problems and harm, including bronchitis, emphysema and laryngitis. If I begin to experience respiratory problems when using marijuana, I will stop using it and report any symptoms to my physician.

Individuals may develop a tolerance to, and/or dependence on, marijuana. I understand that if I require increasingly higher doses to achieve the same benefit or if I think that I may be developing a dependency on marijuana, I should contact my physician.

Symptoms of marijuana overdose include, but are not limited to, nausea, vomiting, hacking cough, disturbances in heart rhythms, numbness in the hands, feet, arms or legs, anxiety attacks and incapacitation. If I experience these symptoms, I agree to contact my physician immediately and/or call 911.

Signs of withdrawal can include: Feelings of depression, sadness, irritability, insomnia, restlessness, agitation, loss of appetite, trouble concentration, sleep disturbances and unusual tiredness. �

I agree to contact my physician, or call 911 in an emergency if I become depressed or psychotic, have suicidal thoughts, or experience crying spells, experience respiratory problems, changes in my normal sleeping patterns, extreme fatigue, increased irritability, or begin to withdraw from my family and/ or friends.

I understand that Aura and its employees are not encouraging me to obtain medical marijuana.

I have had the opportunity to discuss these matters with an Aura representative and to ask questions regarding anything I may not understand or that I need clarified.

I hereby acknowledge Aura and its employees are not addressing specific aspects of my medical care nor are any of them my primary care provider. Furthermore, I, for myself, my heirs, assigns, or anyone acting on my behalf, hold Aura and its principals, agents, and employees free of and harmless from any responsibility for any harm resulting to me and/or other individuals as a result of my marijuana use.

I certify that I fully understand the potential risks and side effects related to the use of marijuana as described above. In using marijuana for medicinal use, I fully accept responsibility and assume the risks and side effects associated with its use.

I agree that Aura and its principals, agents and employees shall not be held responsible for any harm resulting to me and/or any other individual(s) as a result of my medicinal use of marijuana.

I understand that there are inherent risks involved in entering any retail establishment or accepting home delivery of marijuana. Those risks include, but are not limited to damage to property or personal injury. In consideration for being allowed to enter into the premises of Aura Compassion Center, or receipt of home delivery from Aura and on behalf of my heirs, release, indemnify, and hold harmless Aura including its officers, employees, representatives, and agents, from and against any present or future claims, losses, liabilities, costs, and expenses for personal injury, including death, property damage, or any other damage, which I may suffer, or for which I may be liable to any other person, related to my entering into the Aura Compassion Center, including the parking lot, walkways and areas surrounding the Compassion Center, or my acceptance of the home delivery of marijuana.

I understand that the premises of Aura’s, the RI Department of Business Regulation, or other state agencies in case of a security or compliance incident, or as Compassion Center are monitored by video recording, and that my likeness and voice may be recorded for Aura’s security and compliance purposes. I understand and agree that said recordings may be made available to law enforcement agencies, the RI Department of Business Regulation, or other state agencies in the case of a security or compliance incident, or as a part of a criminal investigation.

I understand that Aura may update its policies based on state law requirements, federal law requirements (exempting the Controlled Substances Act), and best practices in providing medical marijuana to Rhode Island patients.
While marijuana has been legalized in several states, it is still illegal under federal law. As a result, transporting cannabis across state lines will result in federal criminal prosecution. The United States Drug Enforcement Agency’s website provides helpful information explaining the penalties for trafficking cannabis. The penalty depends on the amount of marijuana being transported and whether it’s the person’s first or second offense.

Under the Supremacy Clause of the constitution, the federal government could prosecute a person engaged in a marijuana business that is otherwise legal under state law. In 2013, the Obama Administration announced it wouldn’t challenge state laws legalizing marijuana. The Deputy Attorney General released a memo outlining the enforcement policies for marijuana, and it didn’t include prosecuting legal retailers complying with state marijuana laws. However, on January 4, 2018, Attorney General Jeff Sessions issued a memo on marijuana enforcement in which he rescinded previous guidance documents regarding marijuana prosecutions and directed U.S. attorneys to enforce the laws enacted by Congress.
By Signing this form you acknowledge that you have read and agree to all policies outlined in the agreement.