Green Bridge Society — Patient Terms, Consents & Policies
I authorize Green Bridge Society to communicate with me via email and text message for purposes related to medical evaluations, telemedicine visits, scheduling, billing, and administrative matters.
I understand:
- Email and text are not secure communication methods and may be intercepted.
- Messages may contain protected health information (PHI), including sensitive topics such as mental health or substance use.
- I may revoke this authorization at any time in writing.
- My treatment is not conditioned on signing this form.
- Once disclosed, PHI may not be protected by federal or state privacy laws.
Effective Period: This authorization remains valid while I am a patient of Green Bridge Society.
This informed consent outlines important considerations related to the use of medical cannabis and the evaluation process.
1. Eligibility & Safety
- Patients with schizophrenia or other psychotic disorders cannot be certified by Green Bridge Society.
- I agree to disclose any history of depression, psychosis, suicide attempts, or significant mental health concerns.
2. Possible Side Effects
- Euphoria, sedation, or dysphoria
- Impaired concentration or memory
- Dizziness, confusion, anxiety, or paranoia
- Delayed reaction time or impaired coordination
- Changes in appetite or blood pressure
- Possible dependence or withdrawal symptoms
3. Legal Considerations
- Smoking cannabis is illegal in Pennsylvania.
- Driving under the influence is illegal in all states.
- Medical marijuana remains illegal under federal law.
- Use is permitted only in private settings.
4. Pregnancy & Mental Health
- Marijuana may be harmful during pregnancy.
- It may worsen psychotic disorders.
5. Interpreter Disclaimer
- Green Bridge Society does not verify interpreter qualifications.
- We are not responsible for privacy breaches or miscommunication by interpreters.
6. Treatment Expectations
- Green Bridge Society does not dispense or sell cannabis.
- We encourage follow-up with your primary care provider for ongoing care.
7. Patient Acknowledgment
I understand and accept the risks and responsibilities associated with medical cannabis. I agree to hold the physician and staff harmless for issues arising from misuse or abuse.
By using this website, you agree to the following terms and conditions.
1. Conditions of Use
By accessing this site, you confirm that you have read and agree to these terms.
2. Age Requirement
You must be at least 18 years old to use this website.
3. Intellectual Property
All content on this website is owned by Green Bridge Society. Unauthorized use, reproduction, or distribution is prohibited.
4. User Accounts
You are responsible for maintaining the security of your login information and for all activities under your account.
5. Applicable Law
These terms are governed by the laws of Pennsylvania.
6. Indemnification
You agree to hold Green Bridge Society harmless against claims arising from misuse of our services.
7. Limitation of Liability
We are not liable for damages resulting from misuse of our website or services.
Green Bridge Society values your privacy. We do not sell or share your personal information.
Information We Collect
- Information you provide during scheduling and certification
- Documents you upload for diagnosis or identification
- Basic analytics used for site performance
How Your Information Is Used
- To process appointments
- To communicate with you
- To meet state medical marijuana program requirements
Your Rights
- You may request corrections to your information.
- You may revoke HIPAA communication consent at any time.
Refunds are issued under the following conditions:
- If the doctor cannot certify you for medical reasons, a full refund is issued.
- Once a doctor completes the consultation call, refunds are not issued.
- Once a certification is issued to the state, you have 90 days to complete your state registration. If not completed, the state removes your certification and new fees apply.
- Diagnostic add-on services (Anxiety, PTSD, Chronic Pain evaluations) are non-refundable.
If you have an issue with our service, we strongly encourage you to contact us directly so we can help resolve the concern.
Important: Disputing a credit card charge after a certification is issued will result in:
- Your certification being canceled with the state
- Loss of your medical marijuana card
- Additional fees from both the doctor and the state to reapply
We will always work with you to resolve any issues — just reach out.

