I hereby authorize my treating Physician, as required by State and Federal Laws including AAHHC regulations, to release my medical information concerning my diagnosis, condition, and/or Recommendation to All American Health and Healing Cooperative, Inc. and its duly authorized representatives.

Membership Agreement
As a qualified patient protected by California Law, Health & Safety Code §11362.5 and §11362.7, et seq., and, in conjunction with California State Senate Bill 420, you are required to read and agree to the following statements to become a member of All American Health and Healing Cooperative, Inc.. Please understand that these are for your protection, as well as ours. Please read the following statements and initial that you have read each where provided. Please sign the bottom of this form confirming that you read each of the statements and understand them.