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ID Card | Patient Name | Date of Birth | Email | Phone | How has medical marijuana helped alleviate your symptoms? | Any negative side effects or adverse reactions | Leave prescription as is or need to contact? | Patient Records | Entry Date |
|---|---|---|---|---|---|---|---|---|---|
 | Frank Filatro | 3/18/1968 | frankvf@msn.com | +19176700023 | Leave the same, no further action needed | November 25, 2023 | |||
 | Dominic Teresi | 3/4/1995 | dominicteresi21@gmail.com | +15615310089 | Leave the same, no further action needed | July 6, 2024 | |||
 | April A Sherman Rozales | 5/17/1973 | april84567@gmail.com | +15616741371 | Helps with everything pain, anxiety, depression | No | Leave the same, no further action needed | December 13, 2024 | |
 | Jeffrey Hoshor | 5/17/1962 | jeffrey.hoshor@gmail.com | +15618535285 | Leave the same, no further action needed | June 26, 2024 | |||
 | Kristine Flynn | 5/9/1973 | reokflynn@gmail.com | +15612528953 | Pain relief and anxiety | No | Leave the same, no further action needed | November 29, 2024 | |
 | John Clark | 10/16/1963 | radhead@sbcglobal.net | +15618668806 | Leave the same, no further action needed | December 4, 2023 | |||
 | Bruce Humphreys | 10/2/1962 | brucehumphreys13@gmail.com | +15617162180 | Pain and anxiety | No | Leave the same, no further action needed | December 30, 2024 | |
 | Susan Baltrus | 5/10/1963 | sbaltrus@comcast.net | +17813633999 | Helps with pain and sleep | No | Leave the same, no further action needed | August 16, 2024 | |
 | Anna Olivares | 8/2/1983 | annaolivares83@gmail.com | +15615426425 | Leave the same, no further action needed | October 13, 2023 | |||
 | Dana Berkowitz | 9/20/1968 | daynadoll0402@yahoo.com | +13058076137 | Relaxes me before bed | No | Leave the same, no further action needed | December 17, 2024 | |
 | Robert Getsoff | 6/4/1952 | getsoffb@gmail.com | +19176899426 | Request Doctor to contact me to make changes | November 9, 2023 | |||
 | Eldar Cohen | 6/3/1986 | ecohen86@gmail.com | +19175674475 | Sleep thoughts relaxes me | No | Leave the same, no further action needed | December 30, 2024 | |
 | Anthony Restaino | 11/2/1988 | a.restiano62@gmail.com | +15618897210 | Calms me down | No | Leave the same, no further action needed,Request Doctor to contact me to make changes | May 20, 2026 | |
 | Cerefino Orozco | 10/11/1974 | ceferinoorozco@gmail.com | +15615728702 | beneficial | have not | Leave the same, no further action needed | August 4, 2025 | |
 | Lee Miller | 10/18/1953 | dutchandnancy@aol.com | +17209987833 | Pain relief | No | Leave the same, no further action needed | May 18, 2026 | |
 | Jesse Alexander | 12/29/2003 | jessealex03@gmail.com | +19545013512 | Leave the same, no further action needed | May 23, 2024 | |||
 | Eliza Maiorino | 7/17/1980 | elizamaiorino@gmail.com | +15617811556 | Anxiety reduction | No | Leave the same, no further action needed | May 15, 2026 | |
 | kimberley kangos | 12/8/1968 | kkangos@msn.com | +16175103862 | Leave the same, no further action needed | November 3, 2023 | |||
 | Dimitris Tourtounis | 11/6/1984 | d.tourtounis@gmail.com | +12015635002 | Leave the same, no further action needed | December 18, 2023 | |||
 | Julie Cheimets | 9/9/1965 | julie.cheimets@gmail.com | +19788288300 | Used MA just use gummies Just edibles | No | Leave the same, no further action needed | November 7, 2024 | |
 | Kenneth Chapman | 8/12/1975 | kchap2828@gmail.com | +19545981155 | Assists with pain | No | Leave the same, no further action needed | April 21, 2026 | |
 | Michael Hicks | 4/27/1969 | elevatormanmichael@hotmail.com | +13054097593 | Relieves arthritic pain | No | Leave the same, no further action needed | September 2, 2025 | |
 | Michele LoMonte-McCarrick | 7/12/1980 | miowtc@aol.com | +19546559242 | It makes the days easy | No | Leave the same, no further action needed | April 13, 2026 | |
 | Robert Mondry | 1/19/1970 | robertmondry1970@gmail.com | +15616030060 | Sleeping much better, edibles help where smoking is inappropriate | Sativa gives me anxiety | Request Doctor to contact me to make changes | September 7, 2024 | |
 | Jason Silberstein | 4/14/1968 | jasonsilbers@gmail.com | +15617066276 | Pain relief helps with sleep | No | Leave the same, no further action needed | January 3, 2025 |
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Patient Renewal Forms
ID Card | Patient Name | Date of Birth | Email | Phone | How has medical marijuana helped alleviate your symptoms? | Any negative side effects or adverse reactions | Leave prescription as is or need to contact? | Patient Records | Entry Date |
|---|---|---|---|---|---|---|---|---|---|
 | Jose Ruiz | 5/14/1969 | redsox.jmrf@yahoo.com | +19546650864 | Less back pain, less depression | No | Leave the same, no further action needed | August 22, 2024 | |
 | Greg Martin | 9/30/1961 | gmartin220@bellsouth.net | +19547757259 | Leave the same, no further action needed | November 15, 2023 | |||
 | Jacqueline Eskenasi | 7/13/1957 | jeskenasi@gmail.com | +15164575605 | Leave the same, no further action needed | January 25, 2024 | |||
 | Richard Alfonso | 3/6/2001 | richardalfonso23@icloud.com | +15616335702 | Yes, helps with sleep and anxiety. | None | Leave the same, no further action needed | August 19, 2024 | |
 | Craig Calver | 3/29/1954 | ccalver@comcast.net | +19547400408 | Helps with pain. Calms me down helps my eyes | No | Leave the same, no further action needed | February 19, 2025 | |
 | Annette Roth | 9/24/1945 | annetteroth@gmail.com | +19084478184 | Helps with pain Helps with sleep Calms me down | No | Leave the same, no further action needed | August 14, 2024 | |
 | Lisa Haldeman | 12/11/1959 | lisahaldeman@aosdata.com | +13474634432 | Reduces anxiety | No | Leave the same, no further action needed | September 23, 2024 | |
 | Alexandra Kropp-Jones | 6/7/2004 | ax.kj04@gmail.com | +19546953199 | it helps reduce my daily chronic symptoms of IBS and related abdominal issues | no thankfully | Leave the same, no further action needed | August 13, 2024 | |
 | Alan Hochfeld | 3/27/1960 | alhochfeld@gmail.com | +15707907035 | Request Doctor to contact me to make changes | January 17, 2024 | |||
 | June Marchese | 2/8/1954 | june.marchese@gmail.com | +15166430121 | Takes away anxiety Helps with joint pain | No | Leave the same, no further action needed | August 12, 2024 | |
 | Zachary Weber | 2/5/1998 | zweberfl@gmail.com | +19546091267 | Helps with pain | No | Leave the same, no further action needed | February 12, 2025 | |
 | Edward Stinson | 11/16/1971 | teddystinson@yahoo.com | +19548656916 | Leave the same, no further action needed | December 7, 2023 | |||
 | Taylor Sweet | 4/1/1999 | rusweet99@hotmail.com | +19548260598 | Medical Marijuana has drastically improved my apatite, allowing me to eat proper portions and maintain my weight. It also helps calm my over active mind for bed, increasing the number of hours I sleep each night. | None | Leave the same, no further action needed | December 15, 2024 | |
 | Deborah Risley | 5/19/1951 | dndriz@gmail.com | +15617038039 | helped the symptoms | no | Leave the same, no further action needed | February 10, 2025 | |
 | Justin Weissfield | 6/1/1975 | jweissfield@gmail.com | +19547787221 | Alleviates ibs helps with sleep | No | Leave the same, no further action needed | December 4, 2024 | |
 | John DeCosta | 8/2/1971 | johndecostamojo11.11@gmail.com | +19542540325 | Back does not seize up anymore Sleeping improved Less anxiety | No | Leave the same, no further action needed | July 31, 2024 | |
 | Aaron Bennett | 8/30/1979 | aaron.e.bennett@gmail.com | +19546511651 | Yes | No | Request Doctor to contact me to make changes | August 7, 2024 | |
 | Susan Dubitsky | 6/2/1948 | sorahdubitsky@gmail.com | +19715063803 | Reduces stress and anxiety Helps with pain Helps with pain Able to work | No | Leave the same, no further action needed | August 14, 2024 | |
 | Amy DeBonis | 5/19/1974 | amycoliver123@yahoo.com | +12158080087 | Yes | No | Leave the same, no further action needed | February 6, 2025 | |
 | Debra Huff | 4/14/1961 | dhuff259@gmail.com | +15616742558 | Leave the same, no further action needed | June 11, 2024 | |||
 | Joel Forman | 3/4/1949 | attorneytreferral@yahoo.com | +15619619941 | Less anxiety and pain | No | Leave the same, no further action needed | August 1, 2024 | |
 | David Hirschorn | 11/16/1959 | david45677@gmail.com | +15163608767 | Uplift mood and relaxes anxiety and stress | No | Leave the same, no further action needed | January 30, 2025 | |
 | Laney Prior | 3/20/2003 | laneyvirginiap@gmail.com | +19542408470 | Calms me in stressful situations Physically abused by parents nightmares | No | Leave the same, no further action needed | January 29, 2025 | |
 | Wesney Torres | 3/23/1993 | wesneytorres01@gmail.com | +17542599076 | Pain relief with numbness and sleep | None | Leave the same, no further action needed | January 29, 2025 | |
 | Katheryn Brush | 3/25/1997 | katieb.brush@gmail.com | +15612224573 | Yes | No | Leave the same, no further action needed | January 28, 2025 |
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