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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Sam McAllister | 5/12/2003 | sammcallister512@gmail.com | +19544158094 | Leave the same, no further action needed | December 6, 2023 | |||
 | Nicole Maldonado | 2/20/1992 | nicole_maldonado92@yahoo.com | +15617036761 | Leave the same, no further action needed | December 6, 2023 | |||
 | Paola Fontanot | 2/16/2000 | montsefontanot@icloud.com | +15617579923 | Leave the same, no further action needed | December 7, 2023 | |||
 | Matthew Rudavsky | 5/23/1981 | mattrudavsky@gmail.com | +18025780504 | Leave the same, no further action needed | December 8, 2023 | |||
 | Christina Cavallo | 7/18/1983 | christna.canteeburyshades@gmail.com | +15613972261 | Request Doctor to contact me to make changes | December 11, 2023 | |||
 | Edmund Conroy | 6/11/1949 | stevecontoyyachts@yahoo.com | +18433245222 | Request Doctor to contact me to make changes | December 11, 2023 | |||
 | Paul Tatasciore | 1/16/1991 | paultat91@gmail.com | +19548642984 | Leave the same, no further action needed | December 12, 2023 | |||
 | Sebastiano Setticasi | 9/28/1991 | ssetticasi@gmail.com | +15613012286 | Leave the same, no further action needed | December 14, 2023 | |||
 | Debra Huff | 4/14/1961 | dhuff259@gmail.com | +15616742558 | Leave the same, no further action needed | December 15, 2023 | |||
 | Glen Huff | 6/18/1970 | enviroac@aol.com | +19547086125 | Leave the same, no further action needed | December 15, 2023 | |||
 | Eric Wellnitz | 6/5/1977 | ericrwellnitz@gmail.com | +15614656615 | Leave the same, no further action needed | December 15, 2023 | |||
 | Joseph Mayhew | 11/16/1984 | jess.mayhew84@gmail.com | +13527139097 | Leave the same, no further action needed | December 18, 2023 | |||
 | Thai Tran | 9/28/1968 | ttrant3064@gmail.com | +17542616816 | Leave the same, no further action needed | December 20, 2023 | |||
 | Michelle Dunaway | 11/27/1962 | spotspotcat@comcast.net | +15618665213 | Leave the same, no further action needed | December 25, 2023 | |||
 | Linda Laymon | 12/21/1967 | alldolledupgf@gmail.com | +19173240742 | Leave the same, no further action needed | December 25, 2023 | |||
 | Drusilla Kelley | 12/20/1950 | druk10112@gmail.com | +15034074496 | Leave the same, no further action needed | December 26, 2023 | |||
 | Craig Stevens | 8/26/1962 | craigstevens14@gmail.com | +15618437084 | Leave the same, no further action needed | December 27, 2023 | |||
 | Linda Laymon | 12/21/1967 | alldolledupgf@gmail.com | +19173240742 | Leave the same, no further action needed | December 29, 2023 | |||
 | Amber Terranova | 10/7/1988 | amb_scott@yahoo.com | +17547790101 | Leave the same, no further action needed | January 3, 2024 | |||
 | Jose Ruiz | 5/14/1969 | redsox.jmrf@yahoo.com | +19546650864 | Leave the same, no further action needed | January 4, 2024 | |||
 | Luis Pimentel Mussi | 10/1/1980 | mylifeoffaith@gmail.com | +14075385766 | Leave the same, no further action needed | January 5, 2024 | |||
 | Luis Pimentel Mussi | 10/1/1980 | mylifeoffaith@gmail.com | +14075385766 | Leave the same, no further action needed | January 5, 2024 | |||
 | Eric Katz | 12/2/1991 | erickatz91@yahoo.com | +19547320522 | Leave the same, no further action needed | January 9, 2024 | |||
 | Rachel Silberstein | 6/22/2001 | rachelsilbers@gmail.com | +15612898416 | Leave the same, no further action needed | January 12, 2024 | |||
 | Shannon Green | 5/15/1982 | sgreen4215@gmail.com | +15613020297 | Leave the same, no further action needed | January 12, 2024 |
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