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Eligibility Test

INSTRUCTIONS: Answer the following questionnaire to learn if you qualify. We will send you a message with the result shortly.

Age 21+

Qualifying medical conditions

*See qualifying medical conditions here

Proof of qualifying medical condition *

Prescription drug photo

Medical certificate or document establishing diagnosis

Medical imaging report (x-ray, MRI, CT-Scan)

I don't have proof of medical diagnosis

Message received, we will assist you shortly.

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