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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 |
|---|---|---|---|---|---|---|---|---|---|
 | April Adler | 6/16/1965 | apriladler@comcast.net | +17542455112 | Leave the same, no further action needed | November 10, 2023 | |||
 | Regina Weinberg | 3/16/1967 | regw100@gmail.com | +17322412677 | Leave the same, no further action needed | November 10, 2023 | |||
 | Carolina Sole Perna | 2/1/1975 | carolinaanasole@gmail.com | +15617064491 | Leave the same, no further action needed | November 10, 2023 | |||
 | James Pasquini | 8/18/1954 | jspasq@hotmail.com | +15612125453 | Leave the same, no further action needed | November 15, 2023 | |||
 | Angela Greenspan | 4/21/1989 | anggreenspan@gmail.com | +17324915409 | Leave the same, no further action needed | November 16, 2023 | |||
 | Brendan Shoplack | 8/5/2004 | brendans25@icloud.com | +12392166369 | Leave the same, no further action needed | November 16, 2023 | |||
 | Ilan Nieuchowicz | 1/7/1978 | ilan@nukofamily.com | +19544940282 | Leave the same, no further action needed | November 18, 2023 | |||
 | Jimmy Jalil | 7/11/1977 | jrjalil77@aol.com | +15612510943 | Leave the same, no further action needed | November 20, 2023 | |||
 | Katheryn Brush | 3/25/1997 | katieb.brush@gmail.com | +15612224573 | Leave the same, no further action needed | November 20, 2023 | |||
 | Oscar Martin | 10/1/1998 | martinjoscar@outlook.com | +17865427914 | Leave the same, no further action needed | November 21, 2023 | |||
 | Carolina Escobar | 9/27/1960 | c_escobar1@hotmail.com | +15612451084 | Leave the same, no further action needed | November 21, 2023 | |||
 | Daniel Markarian | 3/5/1963 | markariandaniek@gmail.com | +15619514144 | Request Doctor to contact me to make changes | November 22, 2023 | |||
 | Evan Ritsick | 12/21/1990 | ecrutsick@gmail.com | +14042935380 | Leave the same, no further action needed | November 22, 2023 | |||
 | Chereth Robinson | 9/11/1977 | chereth.robinson@gmail.com | +12108968700 | Leave the same, no further action needed | November 22, 2023 | |||
 | Deirdre Lachner | 12/4/1968 | dlachner@comcast.net | +17703569992 | Leave the same, no further action needed | November 22, 2023 | |||
 | Tiffany Williamson | 10/6/1998 | tiffanyxwilliamson@outlook.com | +15617064405 | Leave the same, no further action needed | November 24, 2023 | |||
 | James Pasquini | 8/18/1954 | jspasq@hotmail.com | +15612120115 | Leave the same, no further action needed | November 26, 2023 | |||
 | Michael Lavelanet | 8/21/1981 | laviidavii@gmail.com | +15614149738 | Request Doctor to contact me to make changes | November 27, 2023 | |||
 | Nicholas Ricci | 5/21/1958 | nick@professional-services.com | +19172172563 | Request Doctor to contact me to make changes | November 27, 2023 | |||
 | Megan Lynam | 10/22/1985 | mlynam18@gmail.com | +13473240869 | Leave the same, no further action needed | November 28, 2023 | |||
 | John Mentecky | 11/12/1994 | jaymentecky@gmail.com | +14122187336 | Request Doctor to contact me to make changes | November 29, 2023 | |||
 | Anthony Stanton | 7/20/1967 | bocatony69@yahoo.com | +12155089416 | Leave the same, no further action needed | November 30, 2023 | |||
 | Anatoly Pritikin | 7/27/1947 | aprit@hotmail.com | +15619006308 | Request Doctor to contact me to make changes | November 30, 2023 | |||
 | Stacey Lederberg | 1/3/1963 | staceylynn36@gmail.com | +19543365464 | Leave the same, no further action needed | December 4, 2023 | |||
 | Michael Lopez | 12/4/1971 | melopez813@gmail.com | +15612517220 | Leave the same, no further action needed | December 5, 2023 |
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