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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Sylvia Winkles | 5/2/1953 | sdwinkles@me.com | +15619264550 | Leave the same, no further action needed | May 20, 2024 | |||
 | Robert Iapaluccio | 3/27/1979 | robertiapacertifiedpharmtech@yahoo.com | +15619290677 | Request Doctor to contact me to make changes | May 21, 2024 | |||
 | Eldar Cohe | 6/3/1986 | ecohen86@gmail.com | +19175674475 | Leave the same, no further action needed | May 22, 2024 | |||
 | Aria Hukki | 11/28/1953 | aria2811@hottmail.com | +15615429540 | Leave the same, no further action needed | May 23, 2024 | |||
 | Jordan Jackson | 11/6/1998 | jjacksonprime5@gmail.com | +15615962439 | Leave the same, no further action needed | May 24, 2024 | |||
 | Jason Silberstein | 4/14/1968 | jasonsilbers@gmail.com | +15617066276 | Leave the same, no further action needed | May 28, 2024 | |||
 | Denise Morales | 1/23/1993 | denisemorales4@gmail.com | +15612122367 | Leave the same, no further action needed | May 30, 2024 | |||
 | Christine Pistone | 2/2/1953 | westies1cs@gmail.com | +15164971210 | Leave the same, no further action needed | May 30, 2024 | |||
 | Stephen Scott | 3/13/1969 | stephenhscottpiano@gmail.com | +19293166182 | Leave the same, no further action needed | May 30, 2024 | |||
 | Bradley Escalante | 6/15/2003 | smar7y14@gmail.com | +15612487757 | Leave the same, no further action needed | June 3, 2024 | |||
 | Cathy Marx | 12/3/1956 | southsoflo@icloud.com | +12174333517 | Leave the same, no further action needed | June 5, 2024 | |||
 | Yael Klopfer | 6/12/1983 | yaeljk@gmail.com | +13055601174 | Leave the same, no further action needed | June 5, 2024 | |||
 | Niña Alter | 7/7/1944 | joyofmusic@gmail.com | +15614456774 | Leave the same, no further action needed | June 5, 2024 | |||
 | Deborah Noel | 11/18/1955 | dnoell@1050caw.com | +15614414517 | Leave the same, no further action needed | June 5, 2024 | |||
 | Joseph Garcia | 2/25/1999 | josephg426@hotmail.com | +15615685591 | Leave the same, no further action needed | June 5, 2024 | |||
 | Kimberly Kango | 12/8/1968 | kkangos@msn.com | +16175103862 | Leave the same, no further action needed | June 6, 2024 | |||
 | Joan Cruz | 5/5/1994 | joansgrove@gmail.com | +19174534157 | Leave the same, no further action needed | June 6, 2024 | |||
 | April Click | 4/16/1986 | aprilclick16@gmail.com | +19547783047 | Leave the same, no further action needed | June 6, 2024 | |||
 | Christopher Breighner | 3/16/1977 | christopherbreighner@gmail.com | +19547097235 | Leave the same, no further action needed | June 7, 2024 | |||
 | Andrew Wilbur | 1/5/1990 | 561dreww@gmail.com | +15613740713 | Request Doctor to contact me to make changes | June 7, 2024 | |||
 | Joel Cooper | 10/27/1944 | skdcoop@gmail.com | +15613078016 | Leave the same, no further action needed | June 10, 2024 | |||
 | Charles Capp | 5/31/1970 | charbcapp@yahoo.com | +14707215388 | Leave the same, no further action needed | June 10, 2024 | |||
 | Donald Altland | 3/18/1955 | don.altland@gmail.com | +12039103193 | Leave the same, no further action needed | June 11, 2024 | |||
 | Irving Goldfarb | 10/13/1953 | agold13@me.com | +19548686051 | Leave the same, no further action needed | June 11, 2024 | |||
 | Michael Zurita | 12/23/1992 | mikez137@gmail.com | +15617274709 | Leave the same, no further action needed | June 11, 2024 |
Marijuana Recommendations
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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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