AZ Marijuana Program Patient Attestation Form MARIJUANA PROGRAM PATIENT ATTESTATIONI,First Name *Last Name *, attest that:I will not divert marijuana to any individual who or entity that is not allowed to possess marijuana pursuant A.R.S. Title 36, Chapter 28.1 and that the information provided in the application is true and correct.SignatureStart signing your signature hereYour browser does not support e-Signature field.Date Submit Attestation Back to Forms Home Make an appointment today