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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Marvin Gleicher | 8/30/1949 | marvingleicher3@gmail.com | +18472746424 | Pain | No | Leave the same, no further action needed | December 26, 2024 | |
 | Danielle Amdur | 12/17/1977 | danielle.r.amdur@gmail.com | +15615832747 | Leave the same, no further action needed | February 9, 2024 | |||
 | Rachel Feldman | 3/28/1975 | rachelfeldman1@mac.com | +15614515300 | It relieves my depression | No | Leave the same, no further action needed | September 9, 2024 | |
 | Testing Testing | 3/3/1992 | softecharun001@gmail.com | +919999999999 | Test | test | Leave the same, no further action needed | August 15, 2024 | |
 | Marvin Gleicher | 8/30/1949 | marvingleicher3@gmail.com | +18472746424 | Leave the same, no further action needed | December 28, 2023 | |||
 | Matthew Janowitz | 11/24/1983 | mattjano@gmail.com | +19546734673 | Helps be relax and sleep Calms my restless legs | No | Leave the same, no further action needed | January 22, 2025 | |
 | Arnesh Mohapatra | 2/28/1999 | arnesh.mohapatra@gmail.com | +15034819107 | Yes | No | Leave the same, no further action needed | November 18, 2024 | |
 | Arnesh Mohapatra | 2/28/1999 | arnesh.mohapatra@gmail.com | +15034819107 | Yes | No | Leave the same, no further action needed | November 18, 2024 | |
 | Toby Katcher | 1/3/1977 | tobykatcher@yahoo.com | +19174507978 | 100% | NA | Leave the same, no further action needed | February 28, 2025 | |
 | Steven Crane | 9/13/1963 | drscrane1@gmail.com | +19545888943 | Improved pain intensity and mobility | No | Leave the same, no further action needed | April 8, 2025 | |
 | Ayden Murphy | 10/8/2003 | aydenm2003@gmail.com | +15612215610 | Leave the same, no further action needed | September 12, 2023 | |||
 | Dawson Miller | 1/15/2000 | dawson.miller011@gmail.com | +17864597253 | Leave the same, no further action needed | September 12, 2023 | |||
 | Amanda King | 5/24/1992 | a.herron.1992@gmail.com | +19895132630 | Leave the same, no further action needed | September 12, 2023 | |||
 | Lisa Pottheiser | 5/10/1966 | lpottheiser@gmail.com | +19173328860 | Leave the same, no further action needed | September 14, 2023 | |||
 | Louis Irizarry | 4/23/1966 | louis.irizarry@icloud.com | +13057988555 | Leave the same, no further action needed | September 14, 2023 | |||
 | Jodi Miller | 2/13/1974 | jodimiller@gmail.com | +15618431376 | Leave the same, no further action needed | September 14, 2023 | |||
 | Dora Ryan | 9/29/1973 | doraryan11@gmail.com | +15616548805 | Leave the same, no further action needed | September 15, 2023 | |||
 | William Stover | 12/9/1953 | wfarfalla@aol.com | +15619454818 | Leave the same, no further action needed | September 16, 2023 | |||
 | Jill Morris | 9/15/1965 | jmorrisphd@yahoo.com | +15617020592 | Leave the same, no further action needed | September 17, 2023 | |||
 | Victoria Robelo | 2/10/1961 | victoriaerobelo@gmail.com | +17862088480 | Leave the same, no further action needed | September 18, 2023 | |||
 | Annette Roth | 9/24/1945 | annetteroth@gmail.com | +19084478184 | Leave the same, no further action needed | September 18, 2023 | |||
 | Scott Lang | 8/22/1966 | scottlang@bellsouth.net | +19545574068 | Leave the same, no further action needed | September 18, 2023 | |||
 | Milagros Falero | 5/9/1972 | tdavila369@gmail.com | +15619399875 | Leave the same, no further action needed,Request Doctor to contact me to make changes | September 18, 2023 | |||
 | Richard Karson | 1/10/1954 | richard.karson@gmail.com | +15163823076 | Leave the same, no further action needed | September 19, 2023 | |||
 | Lana Almasri | 10/30/1998 | lanaalmasri@yahoo.com | +15868720535 | Leave the same, no further action needed | September 20, 2023 |
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