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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Eric Kleinberg | 5/29/1960 | eakm30@yahoo.com | +15615040331 | Leave the same, no further action needed | January 19, 2024 | |||
 | Peter Sholy | 4/24/1987 | sholypeter@gmail.com | +15614500190 | Leave the same, no further action needed | January 19, 2024 | |||
 | Dominic Paris | 8/30/1993 | metaldisdom@gmail.com | +15619518192 | Leave the same, no further action needed | January 20, 2024 | |||
 | GLENN WALKER | 7/18/1956 | godwalk@mac.com | +15619014010 | Leave the same, no further action needed | January 23, 2024 | |||
 | Elie Laporte | 8/25/1999 | elielaporte@gmail.com | +19548804555 | Leave the same, no further action needed | January 24, 2024 | |||
 | Cathy Marx | 12/3/1956 | southsoflo@icloud.com | +12174333517 | Leave the same, no further action needed | January 26, 2024 | |||
 | Wayne Whitfield | 5/4/1967 | waynewhit03@yahoo.com | +13057938855 | Leave the same, no further action needed | January 30, 2024 | |||
 | Nadia Cruz | 1/25/1989 | ncruz125@gmail.com | +19173597669 | Leave the same, no further action needed | February 1, 2024 | |||
 | Gerrard Gracie | 9/8/1965 | gerrygracie702@gmail.com | +15616729511 | Leave the same, no further action needed | February 1, 2024 | |||
 | Brent Joy | 3/17/1963 | brentjoy@yahoo.com | +17274804127 | Request Doctor to contact me to make changes | February 2, 2024 | |||
 | William Berry ii | 2/10/1983 | vulcanwill@gmail.com | +15315175359 | Leave the same, no further action needed,Request Doctor to contact me to make changes | February 3, 2024 | |||
 | Rachael Herbert | 3/20/1983 | rachaelmcivir@gmail.com | +17343532569 | Leave the same, no further action needed | February 3, 2024 | |||
 | Livianna Kienle | 1/27/2005 | livianna.kienle@gmail.com | +15615739312 | Request Doctor to contact me to make changes | February 4, 2024 | |||
 | Alan Margolis | 1/26/1961 | alanm@leases.net | +19542750287 | Leave the same, no further action needed | February 5, 2024 | |||
 | Cathy Marc | 12/3/1956 | douthsiglo@icloud.com | +12174333517 | Leave the same, no further action needed | February 5, 2024 | |||
 | Lee Yaffe | 5/15/1965 | leeyaffe45@gmail.com | +16173201110 | Leave the same, no further action needed | February 5, 2024 | |||
 | Lawrence Frydman | 10/19/1968 | larry@thirdfloorloft.com | +19177977978 | Leave the same, no further action needed | February 6, 2024 | |||
 | Robert Mondry | 1/19/1970 | robertmondry1970@gmail.com | +15616030060 | Leave the same, no further action needed | February 6, 2024 | |||
 | Alan Margolis | 1/26/1961 | alanm@leases.net | +19542750287 | Leave the same, no further action needed | February 6, 2024 | |||
 | geoffrey carmichael | 11/27/1982 | scsteel9210@gmail.com | +15617670868 | Leave the same, no further action needed | February 9, 2024 | |||
 | Geoffrey Carmichael | 11/27/1982 | scsteel9210@gmail.com | +15617670868 | Leave the same, no further action needed | February 9, 2024 | |||
 | Jack granofsky | 2/22/1943 | jackgranifsky@gmail.com | +15612131563 | Leave the same, no further action needed | February 10, 2024 | |||
 | Fruma Granofsky | 7/1/1944 | pennygranofsky@gmail.com | +15612135375 | Leave the same, no further action needed | February 10, 2024 | |||
 | Justin Boruchov | 4/15/1983 | justinboruchov@gmail.com | +19172824665 | Leave the same, no further action needed | February 12, 2024 | |||
 | Troy Fisher | 2/27/1978 | tfish227@gmail.com | +19174203200 | Leave the same, no further action needed | February 12, 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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