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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Brady Miller | 8/19/2000 | bradyvincent2000@gmail.com | +13212614152 | Leave the same, no further action needed | February 22, 2024 | |||
 | Joan Wetcher | 12/6/1951 | joan720548@aol.com | +19546480841 | Leave the same, no further action needed | February 23, 2024 | |||
 | Lara Nicholson | 8/8/1969 | lara@ewms.com | +18477221518 | Leave the same, no further action needed | February 26, 2024 | |||
 | Maria Gonzalez | 6/15/1978 | chuchi555@yahoo.com | +15617670312 | Leave the same, no further action needed | February 26, 2024 | |||
 | Cindy Roark | 4/26/1969 | cvr677@mail.harvard.edu | +18133738078 | Leave the same, no further action needed | February 29, 2024 | |||
 | Jackson Cochran | 2/11/2003 | jacksoncoch@gmail.com | +13095320892 | Leave the same, no further action needed | March 5, 2024 | |||
 | Amanda Lawhorne | 5/14/1985 | a.ehrlich0@gmail.com | +15614002377 | Leave the same, no further action needed | March 5, 2024 | |||
 | David Beattie | 5/23/1982 | btconchltl@aol.com | +15612898040 | Leave the same, no further action needed | March 6, 2024 | |||
 | Ryan Almeida | 6/22/1992 | ryanalmeida2010@hotmail.com | +15085259717 | Leave the same, no further action needed | March 7, 2024 | |||
 | Lance Davlin | 5/5/1960 | lbdavlin@mac.com | +17574394331 | Request Doctor to contact me to make changes | March 7, 2024 | |||
 | Joanne Davlin | 1/24/1961 | jojodav@mac.com | +17575727717 | Leave the same, no further action needed | March 7, 2024 | |||
 | Barrie Millen | 5/5/1972 | bmillen20817@gmail.com | +15614008490 | Leave the same, no further action needed | March 7, 2024 | |||
 | Zachariah Anderson | 9/28/1983 | z_ander77@yahoo.com | +15612511319 | Request Doctor to contact me to make changes | March 8, 2024 | |||
 | Joseph Rossi | 11/27/1985 | joerossi23x@yahoo.com | +15613867797 | Leave the same, no further action needed | March 8, 2024 | |||
 | Michael Terranova | 8/23/1989 | m_terranova@hotmail.com | +19542631392 | Leave the same, no further action needed | March 8, 2024 | |||
 | Javin Downing | 9/21/1986 | javindowningz@gmail.com | +19545441399 | Request Doctor to contact me to make changes | March 8, 2024 | |||
 | JACK FROST | 1/4/1955 | jack_fro@msn.com | +19544643884 | Leave the same, no further action needed | March 9, 2024 | |||
 | Bradley Maged | 1/15/1972 | maged@magedrost.com | +16178187050 | Leave the same, no further action needed | March 11, 2024 | |||
 | Alan Silverman | 3/1/1960 | alansilverman202@hotmail.com | +15619010033 | Leave the same, no further action needed | March 11, 2024 | |||
 | John Lovecchio | 9/21/1983 | jjlove26@gmail.com | +15619399722 | Leave the same, no further action needed | March 11, 2024 | |||
 | Charles Giardina | 7/30/1955 | cgiardina@ymail.com | +15163531322 | Leave the same, no further action needed | March 12, 2024 | |||
 | James Klitzberg | 2/7/1975 | james@klirzberg.com | +15616994395 | Leave the same, no further action needed | March 12, 2024 | |||
 | Alyssa Zygala | 6/9/2000 | alyssa.zygala@gmail.com | +19547902504 | Leave the same, no further action needed | March 14, 2024 | |||
 | Jartod Levins | 9/27/1982 | jarrodlevins@gmail.com | +15613504764 | Leave the same, no further action needed | March 14, 2024 | |||
 | Samuel Palestine | 5/18/1951 | samrun@aol.com | +15088898244 | Leave the same, no further action needed | March 14, 2024 |
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