Registration – Microdose Mushroom Dispensary

To sign up as a customer we just need to confirm that you are an adult and promise to use our products responsibly.

Please fill out this form and upload a copy of a valid ID.

We will respond by email within 1 business day at most. (Please check your spam folder if you don’t see an email from us.)

All records are kept private and will never be shared with anyone. ID image is deleted immediately upon confirmation.

All customer purchase records are deleted after 3 months.

Thank you.

registration problems?
email us: [email protected]

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

This field is hidden when viewing the form

ACTIVATION

ACTIVATE

Name*

First Last

Email Address*

Mailing Address*

Number, Street and Suite City Province Postal Code

Phone Number

Confirmation of therapeutic use*

I confirm that I will use these products for therapeutic purposes.

Confirmation of age*

If you are under 19 please contact us for more information.

I am over 19 years old.

Upload a photo ID*

Maximum file size is 64 MB. This document is simply used to confirm your age. We delete this file and do not keep it.

Accepted file types: jpeg, jpg, gif, png, pdf, Max. file size: 64 MB.

Is there anything else you would like to ask or to add?