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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Jeff Martin | 2/15/1958 | jmartinpersonal@yahoo.com | +15615263512 | Leave the same, no further action needed | December 14, 2023 | |||
 | Tova Brocco | 9/13/2001 | tova.brocco@gmail.com | +15612510942 | Leave the same, no further action needed | December 14, 2023 | |||
 | Valerie Glover | 4/14/1970 | 3jdsmom@gmail.com | +13073318788 | Leave the same, no further action needed | December 15, 2023 | |||
 | Olivia Leisure | 9/28/1998 | olivelei17@gmail.com | +15613138653 | Leave the same, no further action needed | December 16, 2023 | |||
 | Petrus Turcanu | 10/2/1970 | lptreal@gmail.com | +15618438432 | Leave the same, no further action needed | December 18, 2023 | |||
 | Michael Cvrlje | 7/26/1992 | mikehenry3923@gmail.com | +16099370756 | Leave the same, no further action needed | December 19, 2023 | |||
 | Evroy Grant | 12/9/1993 | craigs8818@gmail.com | +15612556120 | Request Doctor to contact me to make changes | December 20, 2023 | |||
 | Maria Perroni De Oliveira | 4/9/1986 | maria.c.peroni@gmail.com | +19544718418 | Leave the same, no further action needed | December 21, 2023 | |||
 | Susan Wexler | 1/15/1969 | sue.wexler@yahoo.com | +15613743369 | Leave the same, no further action needed | December 21, 2023 | |||
 | Mallory Halperin | 9/27/1958 | malstang@aol.com | +19548210084 | Leave the same, no further action needed | December 21, 2023 | |||
 | Kamil Khadr | 2/1/1957 | nyfoodman@gmail.com | +15619673065 | Request Doctor to contact me to make changes | December 22, 2023 | |||
 | Mikey Marks | 10/27/1980 | mikey_marks@yahoo.com | +15615632212 | Request Doctor to contact me to make changes | December 22, 2023 | |||
 | Isadore Greenspan | 8/1/1994 | izthewiz44@gmail.com | +19174390976 | Leave the same, no further action needed | December 26, 2023 | |||
 | Jerold Tilden | 10/20/1953 | jerold.tilden@comcast.net | +18054554807 | Leave the same, no further action needed | December 27, 2023 | |||
 | Elizabeth Fisher | 3/23/1966 | lfisher0323@gmail.com | +15615236893 | Leave the same, no further action needed | December 28, 2023 | |||
 | Roberta Polins | 12/17/1946 | robertapolins@gmail.com | +16034938886 | Leave the same, no further action needed | January 3, 2024 | |||
 | Gabrielle Lasure | 1/29/2002 | yorkiebeak@gmail.com | +17726437898 | Leave the same, no further action needed | January 4, 2024 | |||
 | Mark Mcginley | 12/24/1984 | mrkmcginley@gmail.com | +15616746292 | Leave the same, no further action needed | January 9, 2024 | |||
 | David Greenberg | 2/22/1949 | rabbidgreenberg@templest.org | +19143930099 | Leave the same, no further action needed | January 9, 2024 | |||
 | Joseph Lemme | 7/21/1948 | josephlemmebassman@gmail.com | +19547446997 | Leave the same, no further action needed | January 15, 2024 | |||
 | Janine Rocca | 5/16/1981 | janinerocca@yahoo.com | +19416852712 | Request Doctor to contact me to make changes | January 15, 2024 | |||
 | Christopher Hamilton | 12/9/1975 | hvmbnn@gmail.com | +15615137307 | Request Doctor to contact me to make changes | January 15, 2024 | |||
 | Dominic Teresi | 3/4/1995 | dominicteresi21@gmail.com | +15615310089 | Leave the same, no further action needed | January 16, 2024 | |||
 | Gregory Sirota | 9/1/2001 | gregorysirota11@yahoo.com | +15616311978 | Request Doctor to contact me to make changes | January 17, 2024 | |||
 | Gary Steiner | 5/17/1956 | gsteiner517@gmail.com | +15163758447 | Leave the same, no further action needed | January 18, 2024 |
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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 | |
 | 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 | |
 | Harry Metrano | 7/27/1984 | 99metrano@gmail.com | +13109220974 | Calming | No | Leave the same, no further action needed | May 8, 2025 |
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