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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Miguel Fonseca Arroyo | 11/28/1974 | porcecarera22@gmail.com | +19543059282 | Pain y anxiety | No | Leave the same, no further action needed | September 20, 2024 | |
 | Carole Lesselbaum | 10/21/1959 | clesselbaum@optonline.net | +16317455155 | Helps with pain | No | Leave the same, no further action needed | September 19, 2024 | |
 | Bonnie Ford | 7/21/1954 | bonnie@crossfiremedia.com | +12016573916 | Relaxes me helps with pain Uplifts me | None | Leave the same, no further action needed | September 13, 2024 | |
 | Alan Margolis | 1/26/1961 | alanm@leases.net | +19542750287 | Helps with pain and sleep | No | Leave the same, no further action needed | September 13, 2024 | |
 | Leslie Morell | 12/2/1946 | lesliemorrell62@gmail.com | +15617889578 | Relaxes me helps me sleep | No | Leave the same, no further action needed | September 10, 2024 | |
 | Mark Morell | 12/14/1952 | mark.morell1@icloud.com | +16153304549 | Calms me helps with pain | No | Leave the same, no further action needed | September 10, 2024 | |
 | Jack Granofsky | 2/22/1943 | jackgranofsky@gmail.com | +15612131563 | Pain relief and relaxes me | None | Leave the same, no further action needed | September 9, 2024 | |
 | Fruma Granofsky | 7/1/1994 | pennygranofsky@gmail.com | +15612135375 | Pain management Calms me down Neuropathy Helps manage my trigenimal neuralgia | None | Leave the same, no further action needed | September 9, 2024 | |
 | Deanne Cappiello | 5/28/1966 | teenick528@aol.com | +15615428766 | Vertigo 24/7 slows it down Reduces anxiety | No | Leave the same, no further action needed | September 3, 2024 | |
 | Fontez Dale | 12/28/1952 | fontezdale@gmail.com | +15619063524 | Keeps pressure down in eyes | No | Leave the same, no further action needed | September 3, 2024 | |
 | Alexandra Kienle | 2/23/1969 | alexkienle69@gmail.com | +15615735587 | Calms me | No | Leave the same, no further action needed | August 30, 2024 | |
 | Livianna Kienle | 1/27/2005 | livianna.kienle@gmail.com | +15615739312 | Calms me down lets me sleep | No | Leave the same, no further action needed | August 30, 2024 | |
 | Angela Lannes | 9/13/1948 | lannesgarcia@yahoo.com | +13054014131 | Relaxes me helps with pain | No | Leave the same, no further action needed | August 26, 2024 | |
 | Jerold Tilden | 10/20/1953 | jerold.tilden@comcast.net | +18054554807 | Calms me down helps me sleep | No | Leave the same, no further action needed | August 22, 2024 | |
 | jerold tilden | 10/20/1953 | jerold.tilden@comcast.net | +18054554807 | yes | none | Leave the same, no further action needed | August 21, 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 | |
 | Tasha Joseph | 10/12/2005 | tashaejoseph2@gmail.com | +14234808008 | Hoping it will help me relax And sleep | No | Leave the same, no further action needed | August 13, 2024 | |
 | Isadore Greenspan | 8/1/1994 | izthewiz44@gmail.com | +19174390976 | Reduced pain and anxiety Sleeping improved | No | Leave the same, no further action needed | August 12, 2024 | |
 | Andrew Walker | 2/15/1958 | andywalk23@gmail.com | +12014248628 | New patient has used | No | Leave the same, no further action needed | August 9, 2024 | |
 | Allicyn Hughes | 3/18/1977 | allicyn77@comcast.net | +19545935364 | Takes stress level down Anxiety better Sleep better Stopped xanex | No | Leave the same, no further action needed | August 6, 2024 | |
 | Jay Widelock | 2/19/1954 | jaywidelock@gmail.com | +19542985812 | Alleviates pain anxiety helps with sleep | No | Leave the same, no further action needed | January 27, 2025 | |
 | Elizabeth Branstetter | 6/29/1966 | starstudio1@icloud.com | +17863757842 | Helps to get through day | No | Leave the same, no further action needed | January 22, 2025 | |
 | Jonathan Isabel-Mendez | 9/1/2002 | jonathanmendez1232@gmail.com | +17729404521 | Marijuana been helping me a lot. Makes me go to sleep quicker from the back pain after a hard day at work. | No, I haven’t experienced any negative side effects from medical marijuana. I’ve been working fine for me | Leave the same, no further action needed | July 31, 2025 | |
 | Jonathan Isabel-Mendez | 9/1/2002 | jonathanmendez1232@gmail.com | +17729404521 | Medical marijuana has helped me so much. Makes me fall asleep, fast faster after a long day of work from back pain | No, I haven’t experienced any satisfaction using medical marijuana | Leave the same, no further action needed | July 31, 2025 | |
 | Isabella Rucci | 3/8/1994 | isabellaarucci@gmail.com | +15615457758 | Yes, substantial difference. Usually when I first feel a migraine coming on I immediately ingest cannabis, once it kicks in my migraine symtoms are extremely reduced and my nausea is controlled and I can function. For my insomnia, I take an edible an hour before I sleep, I go right to bed and stay a sleep all night. Without, I cannot sleep for hours, tossing and turning, never sleep through the night, wake up multiple times. For my depression, I inhale for quick relief whereas without cannabis I would become so upset I would hide myself in my room and never leave. WITH cannabis, instant relief when I start to feel depressed and can actually go on with my day and be functional. It has changed my life tremendously! | No, not as of yet. | Leave the same, no further action needed | January 24, 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 |
|---|---|---|---|---|---|---|---|---|---|
 | Laura Winston | 9/13/1962 | laurafromfl@yahoo.com | +15613864743 | Sleep and reduces anxiety I care for my elderly mother | No | Leave the same, no further action needed | November 11, 2024 | |
 | Georgiana Forker | 5/4/1950 | gforker12@gmail.com | +15165216130 | Takes pain away Helps with ulcerative colitis And IBS | No | Leave the same, no further action needed | July 29, 2024 | |
 | Frank Romeo | 11/24/1963 | frankmoble2@gmail.com | +15613507945 | Yes | No | Leave the same, no further action needed | December 28, 2024 | |
 | Kevin Forker | 1/9/1959 | kf3947@msn.com | +15165216129 | Allieviates pain calms anxiety relaxes eye | No | Leave the same, no further action needed | July 29, 2024 | |
 | Earl Sands | 5/21/1963 | michaelsands9mm@gmail.com | +19544059108 | Helps with pain | No | Leave the same, no further action needed | December 12, 2024 | |
 | David Beattie | 5/23/1982 | btconchltl@aol.com | +15612898040 | Helps me sleep a lot better, also less depressed. | no. | Leave the same, no further action needed | August 16, 2024 | |
 | Judith Jacobs | 12/7/1956 | dancejj111@aol.com | +15617194250 | Helps with Pain anxiety | No | Leave the same, no further action needed | January 12, 2025 | |
 | Ryan Thomas | 11/9/1970 | rthomas@thomaseg.com | +15616621410 | Relieves pain and anxiety | No | Leave the same, no further action needed | November 18, 2025 | |
 | Michael Berez | 1/30/1979 | michaelberez@gmail.com | +19172392916 | Yes I’ve been able to manage anxiety | No | Leave the same, no further action needed | October 30, 2024 | |
 | Nathan Lang | 7/13/2007 | nathancorbettlang@yahoo.com | +13392369204 | Relaxes me | No | Leave the same, no further action needed | June 8, 2026 | |
 | Ryan Almeida | 6/22/1992 | ryanalmeida2010@hotmail.com | +15085259717 | It helps with pain, allowing me to eat. Helps alleviate bouts of dread an hopelessness. | No | Leave the same, no further action needed | September 25, 2024 | |
 | Alistair Wilgress-Pipe | 9/6/1997 | alistairwp@aol.com | +17247993677 | Leave the same, no further action needed | November 29, 2023 | |||
 | Vincent Montalbano | 10/13/1990 | shady4lyfe1@yahoo.com | +19542536411 | Helped me manage day to day and be a better mood. | No negative | Leave the same, no further action needed | August 22, 2024 | |
 | Angela Thompson | 3/8/1981 | angelaallen123@yahoo.com | +15618172315 | Pain anxiety sleep nightmares | None | Leave the same, no further action needed | December 18, 2024 | |
 | Michael Kaplan | 4/1/1962 | kaplan.mike@gmail.com | +15187634000 | Calms me down reduces stress Alleviates Pain | No | Leave the same, no further action needed | October 26, 2024 | |
 | Olivia Katz | 11/23/2003 | oliviakatz03@gmail.com | +15618841334 | Calms me down helps sleeo | No | Leave the same, no further action needed,Request Doctor to contact me to make changes | October 28, 2025 | |
 | Mark Noell | 2/18/1955 | mnoell@1050caw.com | +15612398519 | Helps with pain | No | Leave the same, no further action needed | May 27, 2026 | |
 | Thai Tran | 9/28/1968 | ttrant3064@gmail.com | +17542616816 | Uplifts me | No | Leave the same, no further action needed | August 12, 2024 | |
 | Amanda Lawhorne | 5/14/1985 | a.ehrlich0@gmail.com | +15614002377 | Yes. Cannabis helps keep my UC in remission | No | Request Doctor to contact me to make changes | September 4, 2024 | |
 | Debbie Brown | 1/13/1976 | debbrown3506@me.com | +13059844404 | I prefer a natural method for dealing with my health issues and have been to school and earned a certification in cannabis medicine and healthcare | No | Leave the same, no further action needed | December 5, 2024 | |
 | Chaim Nissel | 12/12/1983 | cnissel100@gmail.com | +17189094124 | Pain and peas symptoms | No | Leave the same, no further action needed | November 27, 2024 | |
 | Deborah Korash | 3/4/1948 | deborahk33496@yahoo.com | +15612125266 | Helps me sleep Calms me Pain relief | No | Leave the same, no further action needed | November 6, 2024 | |
 | Victor Maia | 1/30/1982 | victor.maia@live.com | +15616132846 | Helped me sleep and improved my anxiety and depression tremendously. | None. | Leave the same, no further action needed | July 19, 2024 | |
 | Jarrod Levins | 9/27/1982 | jarrodlevins@gmail.com | +15613504764 | Calms me | No | Leave the same, no further action needed | September 10, 2024 | |
 | Christina Cavallo | 7/18/1983 | christina.canterburyshades@gmail.com | +15613972261 | Relaxes me uplifts me | No | Leave the same, no further action needed | October 10, 2024 |
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