Schedule An OMMA Renewal Recommendation

Is this a new recommendation or an OMMA renewal?*
- First Time, New Recommendation
- OMMA Renewal (Existing Cardholder)
Legal Name*
Enter your legal name just as it appears on your Oklahoma DL or state-issued ID.
First Middle Last
Your Email*
Mobile Phone*
For your confidential telemedicine appointment, a camera-enabled smartphone is helpful. However, you may use any pc or tablet with a front-facing camera and microphone.
Text Message / SMS Opt-In*
- I agree to receive text messages for appointment updates and renewal reminders.
By checking this box, you agree to receive text message at the mobile number provided above regarding your telemedicine visit and futures renewal reminders. Message frequency may vary. Standard message and data rates may apply. Text HELP for help. Text STOP to cancel.
Choose Appointment Day & Time*
This field is hidden when viewing the form
Telemedicine Appointment Type (HIDDEN DO NOT REMOVE)
State Issued Photo ID
Max. file size: 1 GB.
Oklahoma photo ID is preferred and simplifies the application process. If you verify identity with a U.S Passport, you will also be required to supply the OMMA with a 2nd source to verify Oklahoma residency such as utility bill, mortgage or lease agreement. Out of State licenses are not accepted as a form of identity.
Physical Address*
Street Address Address Line 2 City State ZIP Code

To simplify the OMMA application process, Your physical address should be shown on your Oklahoma photo ID. If your physical address is different, you will be required to provide another source (utility bill, mortgage, or lease) to verify you are an Oklahoma resident.
Date of Birth* (min age: 18)
MM slash DD slash YYYY
Telemedicine Doctor Consultation*
Price:
You will submit your payment in the next step through a secure Square checkout. Remember, if for any reason you do not receive a recommendation, we will refund 100% of your consultation fee.
Coupon
Total
$0.00

Credit Card

Cardholder Name

Card Details

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OMMA RENEWALS

Interested in a patient drive? clinic@ommarenewals.com

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QUESTIONS?

Our staff wants to help.
918-682-3700

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Statewide

Medical Card Referrals in all
77 Oklahoma Counties

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PHONE HOURS

10:00am – 6:00pm
Monday - Friday