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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Arnesh Mohapatra | 2/28/1999 | arnesh.mohapatra@gmail.com | +15034819107 | Calms me helps me sleep | No | Leave the same, no further action needed | November 15, 2024 | |
 | Joel Hartstone | 12/10/1945 | jstonegate@att.net | +18609304975 | Helps pain and anxiety | No | Leave the same, no further action needed | November 8, 2024 | |
 | Manly Ray | 4/21/1966 | manly.ray@gmail.com | +15612367581 | Allows me to sleep well Helps with pain Calms me | No | Leave the same, no further action needed | November 6, 2024 | |
 | Joshua Sauer | 6/7/1985 | josh@ckautos.com | +19542184166 | Yes | No | Leave the same, no further action needed | October 28, 2024 | |
 | Adam Peters | 7/27/1982 | mcfaddan23@gmail.com | +15612354444 | MM has helped maintain a calm and stable life. | No. | Leave the same, no further action needed | October 22, 2024 | |
 | Kara Sitterson | 3/10/1987 | taylaann09@gmail.com | +15617199990 | Helps pain. Can eat reduces anxiety | No | Request Doctor to contact me to make changes | October 22, 2024 | |
 | Giovanni Matire | 8/16/2001 | gmatire@gmail.com | +15616544104 | Helps with ADHD calms me | No | Leave the same, no further action needed | October 22, 2024 | |
 | Anatoly Pritikin | 7/27/1947 | aprit@hotmail.com | +15619006308 | Pain and anxiety | No | Leave the same, no further action needed | October 22, 2024 | |
 | David Etzler | 2/10/2024 | davidetzler@yahoo.com | +15612123273 | Relaxes me calms me down alleviates my migraines | No | Leave the same, no further action needed | October 14, 2024 | |
 | Joseph Rossi | 11/27/1985 | joerossi23x@yahoo.com | +15613867797 | Helps all around. | No. | Leave the same, no further action needed | October 9, 2024 | |
 | Stephen Stienman | 6/21/1940 | ssteinman40@gmail.com | +12013946739 | Helps with pain | No | Leave the same, no further action needed | October 4, 2024 | |
 | Nivaldo Ferreira | 1/16/1983 | njfhomerepair@gmail.com | +17742495771 | Helps with psin | No | Leave the same, no further action needed | October 7, 2024 | |
 | Caren Raimondi | 7/5/1959 | carenraimondi46@gmail.com | +15612512828 | Relaxes me Reduces anxiety Uplifts me | None | Leave the same, no further action needed | October 1, 2024 | |
 | Todd Wolosoff | 6/1/1955 | twolosoff@gmail.com | +15169723768 | Helps me sleep | No | Leave the same, no further action needed | September 14, 2024 | |
 | Todd Wolosoff | 6/1/1955 | twolosoff@gmail.com | +15169723768 | Helps me sleep | No | Leave the same, no further action needed | September 14, 2024 | |
 | Vicki Danelutti | 12/12/1960 | vickidanelutti@yahoo.com | +15613023285 | Helps me sleep | No | Leave the same, no further action needed | September 9, 2024 | |
 | Nathaniel Burstin | 7/12/1983 | nateburstin@gmail.com | +19737256219 | Relaxes me | None | Leave the same, no further action needed | September 4, 2024 | |
 | Trevor Rubino | 6/4/1985 | tbino1207@outlook.com | +15615748037 | I am able to function outside around other people normally. | No | Leave the same, no further action needed | August 30, 2024 | |
 | Adam Gillman | 3/25/1985 | adam.gillman@gmail.com | +13129614540 | Sleep | No | Leave the same, no further action needed | August 28, 2024 | |
 | Danielle A | 12/17/1977 | danielle.r.amdur@gmail.com | +15615832747 | It is beyond beneficial and I don't think I would function very well without it. | No, never. | Request Doctor to contact me to make changes | August 24, 2024 | |
 | Nicholas Ricci | 5/21/1958 | nick@professional-services.com | +19172172563 | Helps with pain Helps with neuropathy | No | Leave the same, no further action needed | August 23, 2024 | |
 | Shannon Green | 5/15/1982 | sgreen4215@gmail.com | +15613020297 | Helps with Focus Balancing energy Reduces Anxiety Fosters sleep Helps with my appetite when I’m in depression mode | No | Request Doctor to contact me to make changes | August 20, 2024 | |
 | Erik Perez | 2/25/1993 | erik_ap930@hotmail.com | +13058500093 | Relaxes my muscles after work out Relaxes me to sleep Reduces my pain | No | Leave the same, no further action needed | August 16, 2024 | |
 | Kathleen Thiessen | 3/23/1962 | kthiessen62@gmail.com | +15617150680 | Allows me to relax | No | Leave the same, no further action needed | August 13, 2024 | |
 | Alan Hochfeld | 3/27/1960 | alhochfeld@gmail.com | +15707907035 | Helps lower my extreme anxiety Helps me sleep | No | Leave the same, no further action needed | August 12, 2024 |
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