Records Release Authorization Form

There are seven dispensing organizations authorized to cultivate, process an dispense medical marijuana:
Truelieve | 850-777-3360 | [email protected]
CHT Medical | 855-524-8633 | [email protected]
The Green Solution | 800-429-1987 | [email protected]
Surterra Therapeutics | 850-391-5455 | [email protected]
Modern Health Concepts | 877-303-0741 |
Knox Medical | 888-441-5669 |[email protected]
GrowHealthy| 863-223-882 | [email protected]

For more information on Medical Cannabis or to schedule your appointment, click here.


Local Compounding Pharmacies
Everwell Specialty Pharmacy | 850-972-8582
Gulf Breeze Apothecary | 850-677-9340

Pensacola Wellness Solutions partners with:
Roberts South Bank for BHRT Pellets | 904-398-9660
University Compounding Pharmacy | 877-531-1147


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Cosmetic Treatment Health History

*The Cosmetic Treatment Health History form is for new patients that are ONLY coming in for cosmetic & esthetic consultations–meaning everyone interested in Botox® and Juvederm®.


Patients can now request or cancel appointments through their patient portal. In order to sign up for patient portal, let our staff know you are interested and we can send you an invitation via email. You will receive an invitation with the setup instructions. Your full email address will be your login ID and your phone number will serve as your PIN. From there it will prompt you to setup the rest of your account where you will be able to view lab orders, medications, diagnoses and more. Learn more about the patient portal.

*PATIENTS PRINTING NEW PATIENT FORMS: When printing off forms, please make sure all forms are printed one-sided. Additionally, any records you are bringing in for documentation need to be one-sided as well and free of any staples. Thank you for your cooperation!