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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Christopher Maranges | 7/30/1984 | maranges1@gmail.com | +15613028505 | Leave the same, no further action needed | May 13, 2024 | |||
 | Hannah Collins | 4/3/2001 | hannahcollinsruth@gmail.com | +14074638767 | Leave the same, no further action needed | June 28, 2024 | |||
 | Chereth Robinson | 9/11/1997 | chereth.robinson@gmail.com | +12108968700 | Leave the same, no further action needed | May 23, 2024 | |||
 | James Belles | 8/18/2025 | jamiebelles1@gmail.com | +14016493398 | Leave the same, no further action needed | June 12, 2024 | |||
 | Joseph Klein | 3/8/1964 | josephdklein@gmail.com | +14102624424 | Leave the same, no further action needed | June 11, 2024 | |||
 | Alexis Baez-zapata | 3/24/2000 | abaez1348@hotmail.com | +19544823625 | Helps me sleep and anxiety | No | Leave the same, no further action needed | January 14, 2025 | |
 | Dara Bialow | 11/13/1976 | dmbialow@aol.com | +19173643613 | i only take the gummies when I cant fall asleep on occasion and they work well. | no | Leave the same, no further action needed | January 14, 2025 | |
 | Nickenson Jacsaint | 10/15/1999 | 3piecesanctuary@gmail.com | +17543265075 | Helps with anxiety sleeping and back pain | No | Leave the same, no further action needed | January 14, 2025 | |
 | Ana Marrazzo | 10/13/1965 | marrazzoana@gmail.com | +15618875089 | Leave the same, no further action needed | April 15, 2024 | |||
 | Timothy Garland | 2/3/1987 | dgk387@yahoo.com | +12019934940 | Relaxes me uplifts me | No | Leave the same, no further action needed | January 7, 2025 | |
 | Ricardo Arevalo | 9/19/1955 | twinterm@aol.com | +13055628248 | Calms him down lowers anxiety | No | Leave the same, no further action needed | January 3, 2025 | |
 | Drusilla Kelley | 12/20/1950 | druk10112@gmail.com | +15034074496 | Hells anxiety and relax to sleep less nightmares | No | Leave the same, no further action needed | January 2, 2025 | |
 | John Mentecky | 11/12/1994 | jaymentecky@gmail.com | +14122187336 | Helps me eat, relax, sleep and exercise. | No | Leave the same, no further action needed | December 31, 2024 | |
 | April Adler | 6/16/1965 | apriladler@comcast.net | +17542455112 | Calms me stops bad thoughts uplifts my mood | None | Leave the same, no further action needed | December 19, 2024 | |
 | Sebastiano Setticasi | 9/28/1991 | ssetticasi@gmail.com | +15613012286 | Helps me sleep Calms me down | No | Leave the same, no further action needed | December 18, 2024 | |
 | Tiffany Williamson | 10/6/1998 | tiffanyxwilliamson@outlook.com | +15617064405 | Relaxes me | No | Leave the same, no further action needed | December 17, 2024 | |
 | JoAnn Garcia | 4/1/1958 | joann948@gmail.com | +17177526621 | Helps my eye pressure and relaxes me | No | Leave the same, no further action needed | December 12, 2024 | |
 | Lana Almasri | 10/30/1998 | lanaalmasri@yahoo.com | +15868720535 | Relaxes me helps with sleep | No | Leave the same, no further action needed | December 11, 2024 | |
 | Danielle Dautry | 6/4/1981 | dautry722@gmail.com | +15614099311 | Helps with anxiety uplifts my mood | No | Leave the same, no further action needed | December 10, 2024 | |
 | Carolina Escober | 9/27/1960 | c_escobar1@hotmail.com | +15612451084 | Reduces stress helps with sleep | No | Leave the same, no further action needed | December 9, 2024 | |
 | Michelle Dowling | 3/6/1991 | mdowlingg6@gmail.com | +16508855525 | Have noticed both functional and clinical improvements in my interstitial cystitis. I'm getting flare ups less often and when I do the medical marijuana helps alleviate those symptoms. | No negative. | Leave the same, no further action needed | December 8, 2024 | |
 | Michelle Dowling | 3/6/1981 | mdowlingg6@gmail.com | +16508855525 | My interstitial cystitis has improved both functionally and clinically. I am having less flare ups and when they seldom happen the medical marijuana curbs a lot of the symptoms. | No negatives | Leave the same, no further action needed | December 8, 2024 | |
 | Stacey Nitkowski | 4/14/1975 | sbnitkowski@yahoo.com | +15617676704 | Been very helpful | No | Leave the same, no further action needed | November 29, 2024 | |
 | Lisa Pottheiser | 5/10/1996 | lpottheiser@gmail.com | +19173328830 | Alleviates pain anxiety and uplifts my mood | No | Leave the same, no further action needed | November 27, 2024 | |
 | Lisa Gerbs | 3/19/1965 | lgerbs1001@gmail.com | +15614459886 | Alleviates pain Sleep | None | Leave the same, no further action needed | November 15, 2024 |
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