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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Richard Leipzig | 12/16/1957 | rleipzig@aol.com | +19176895858 | Leave the same, no further action needed | October 13, 2023 | |||
 | Marcelo Souza | 5/21/1980 | mtelless@gmail.com | +14698535844 | Leave the same, no further action needed | October 13, 2023 | |||
 | Jeffrey Gottlieb | 5/16/1973 | gottlieb.jeff@gmail.com | +15617042816 | Leave the same, no further action needed | October 13, 2023 | |||
 | Stephanie Marcus | 6/27/1972 | stephbeth627@hotmail.com | +15612219354 | Leave the same, no further action needed | October 15, 2023 | |||
 | Joseph Klein | 3/8/1964 | josephdklein@gmail.com | +14102624424 | Leave the same, no further action needed | October 16, 2023 | |||
 | Pamela Dabah | 9/3/1954 | pameladabah@gmail.com | +19734793385 | Leave the same, no further action needed | October 16, 2023 | |||
 | Francis Smith | 6/28/1973 | rickynoodlesoup@gmail.com | +15613198300 | Leave the same, no further action needed | October 16, 2023 | |||
 | Robert Preston | 5/31/1954 | rprestonodi@gmail.com | +15612137124 | Leave the same, no further action needed | October 16, 2023 | |||
 | Michael Nasiff | 2/7/1986 | michaelnasiff@gmail.com | +15618068939 | Leave the same, no further action needed | October 17, 2023 | |||
 | Marvin Finkelstein | 12/17/1962 | marvin@kripke.com | +15612120028 | Leave the same, no further action needed | October 20, 2023 | |||
 | Judith Jacobs | 12/7/1956 | dancejj111@aol.com | +15617194250 | Leave the same, no further action needed | October 23, 2023 | |||
 | Jessica Pena | 7/10/1988 | jesspena710@icloud.com | +18457930626 | Leave the same, no further action needed | October 23, 2023 | |||
 | Kely Dellovo | 11/3/1970 | vkdellobo@aol.com | +15614146781 | Leave the same, no further action needed | October 25, 2023 | |||
 | Vincent Deangelis | 4/25/1994 | vdeangelis4180@gmail.com | +15612683205 | Request Doctor to contact me to make changes | October 28, 2023 | |||
 | Lawrence Martino | 1/13/1947 | lpmartino@yahoo.com | +14048867398 | Leave the same, no further action needed | October 31, 2023 | |||
 | Fred Silberstein | 3/10/1971 | fred@sfpadvisors.com | +19546292084 | Leave the same, no further action needed | November 1, 2023 | |||
 | Lance Lewis | 11/23/1976 | lancethan@yahoo.com | +17543049451 | Leave the same, no further action needed | November 1, 2023 | |||
 | Todd Wolosoff | 6/1/1955 | twolosoff@gmail.com | +15169723768 | Leave the same, no further action needed | November 2, 2023 | |||
 | Todd Lighter | 2/6/1965 | toddlighter@hotmail.com | +15614144356 | Leave the same, no further action needed | November 4, 2023 | |||
 | Sean Stevens | 6/28/1982 | sean-stevens@live.com | +15613507986 | Leave the same, no further action needed | November 6, 2023 | |||
 | Sean Stevens | 6/28/1982 | sean-stevens@live.com | +15613507986 | Leave the same, no further action needed | November 6, 2023 | |||
 | Mike Cohen | 5/16/1970 | mikec51670@yahoo.com | +15613014105 | Leave the same, no further action needed | November 6, 2023 | |||
 | Hannah Collins | 4/3/2001 | hannahcollinsruth@gmail.com | +14074638767 | Leave the same, no further action needed | November 8, 2023 | |||
 | Linda Howard | 3/7/1947 | drlbh47@aol.com | +15619017260 | Request Doctor to contact me to make changes | November 9, 2023 | |||
 | Christine McMahon-Nebe | 2/2/1980 | kristitissy@gmail.com | +19548547432 | Leave the same, no further action needed | November 10, 2023 |
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