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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Jacqueline Nelson | 12/4/1979 | jackiea1204@yahoo.com | +15619850673 | Leave the same, no further action needed | January 12, 2024 | |||
 | Hugo Solano | 12/3/1980 | davidsolano02@yahoo.com | +15616354787 | Leave the same, no further action needed | January 16, 2024 | |||
 | Annette Roth | 9/24/1945 | annetteroth@gmail.com | +19084478184 | Leave the same, no further action needed | January 19, 2024 | |||
 | Jodi Hager | 12/28/1992 | jfh9629@yahoo.com | +15619036404 | Leave the same, no further action needed | January 22, 2024 | |||
 | Steven Jia | 6/17/1999 | sjia99@gmail.com | +15612359918 | Leave the same, no further action needed | January 23, 2024 | |||
 | Toby Katcher | 1/3/1977 | tobykatcher@yahoo.com | +19174507978 | Leave the same, no further action needed | January 24, 2024 | |||
 | Elizabeth Bensassi | 4/29/1988 | elizabeth.moran429@gmail.com | +15165514624 | Leave the same, no further action needed | January 26, 2024 | |||
 | Rachel Feldman | 3/28/1975 | rachelfrldman1@mac.com | +15614515300 | Leave the same, no further action needed | January 31, 2024 | |||
 | Caren Raimondi | 7/5/1959 | carenraimondi46@gmail.com | +15612512828 | Leave the same, no further action needed | February 1, 2024 | |||
 | Maria Buska | 4/1/1968 | rmaria986@icloud.com | +17322678098 | Request Doctor to contact me to make changes | February 2, 2024 | |||
 | Eileen Steinman | 8/11/1944 | rede18@aol.com | +12019607947 | Request Doctor to contact me to make changes | February 5, 2024 | |||
 | Stephen Steinman | 6/21/1940 | ssteinman40@gmail.com | +12013946739 | Leave the same, no further action needed | February 5, 2024 | |||
 | Gary Hecht | 8/8/1946 | ghecht08@gmail.com | +19543836448 | Leave the same, no further action needed | February 5, 2024 | |||
 | Lauren Schwartz | 5/19/1948 | lms4840@hotmail.com | +15165094139 | Leave the same, no further action needed | February 6, 2024 | |||
 | Deven Ali | 11/5/2001 | devenbb83@gmail.com | +15617036738 | Leave the same, no further action needed | February 9, 2024 | |||
 | Lisa Haldeman | 12/11/1959 | lisahaldeman@aosdata.com | +13474634432 | Request Doctor to contact me to make changes | February 10, 2024 | |||
 | Diane Martin | 5/21/1954 | dianemartin3583@gmail.com | +19543095659 | Request Doctor to contact me to make changes | February 12, 2024 | |||
 | Adam Peters | 7/27/1982 | mcfaddan23@gmail.com | +15612354444 | Leave the same, no further action needed | February 13, 2024 | |||
 | Nickenson Jacsaint | 10/15/1999 | 3piecesanctuary@gmail.com | +15618867477 | Leave the same, no further action needed | February 13, 2024 | |||
 | Richard Alfonso | 3/6/2001 | richardalfonso23@icloud.com | +15616335702 | Leave the same, no further action needed | February 14, 2024 | |||
 | Trevor Rubino | 6/4/1985 | tbino1207@outlook.com | +15615748037 | Leave the same, no further action needed | February 14, 2024 | |||
 | Dionisia Salazar | 11/12/1974 | unicornexpert@att.net | +15617562348 | Leave the same, no further action needed | February 15, 2024 | |||
 | Christi Parsons | 1/26/1982 | christi.parsons82@gmail.com | +15614517522 | Leave the same, no further action needed | February 15, 2024 | |||
 | Kathleen Kolehma | 9/9/1999 | katie.kolehma@gmail.com | +19546511226 | Leave the same, no further action needed | February 19, 2024 | |||
 | Leeann May | 5/28/1988 | leeannmay528@gmail.com | +19546556479 | Leave the same, no further action needed | February 20, 2024 |
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