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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Danielle Nemarich | 4/16/1970 | nemarich@comcast.net | +18602501642 | Anxiety and migraine pain relief | No | Leave the same, no further action needed | December 4, 2024 | |
 | Daniel Sirota | 4/20/1985 | dansirota@gmail.com | +16313799464 | Yes | No | Leave the same, no further action needed | April 26, 2026 | |
 | Bonnie Yablon | 11/10/1953 | bonnieland@me.com | +15703527400 | Pain relief | No | Leave the same, no further action needed | January 7, 2025 | |
 | Lara Nicholson | 8/8/1969 | lara@ewms.com | +18477221518 | Helps with pain and sleep | No | Leave the same, no further action needed | October 10, 2024 | |
 | Regina Weinberg | 3/16/1967 | regw100@gmail.com | +17322412677 | Pain and calms me | No | Leave the same, no further action needed | December 30, 2024 | |
 | Terrence Barnhardt | 6/1/1955 | tbarnhardt@fau.edu | +19792244608 | Held with sleep and pain | No | Leave the same, no further action needed | April 14, 2026 | |
 | Brian Feder | 12/4/1979 | bfeder7@gmail.com | +17026091300 | Leave the same, no further action needed | February 22, 2024 | |||
 | James Shaw | 9/26/1980 | shawman80@yahoo.com | +17162282515 | Relieve pain | Done | Leave the same, no further action needed | November 25, 2024 | |
 | Maria Gonzalez | 6/15/1978 | chuchi555@yahoo.com | +15617670312 | Sleep through night and anxiety | No | Leave the same, no further action needed | October 6, 2024 | |
 | Caren Raimondi | 7/5/1959 | carenraimondi46@gmail.com | +15612512828 | Relaxes me Reduces anxiety Uplifts me | No | Leave the same, no further action needed | October 3, 2024 | |
 | Joel Weingast | 10/20/1948 | jweingast@bellsouth.net | +12018741292 | Sleep and anxuery | None | Leave the same, no further action needed | December 4, 2024 | |
 | Richard Karson | 1/10/1954 | richard.karson@gmail.com | +15163823076 | Alleviates nagging pain | None | Leave the same, no further action needed | December 19, 2024 | |
 | Richard Lehrer | 5/28/1953 | richardlehrer@gmail.com | +15166106555 | Request Doctor to contact me to make changes | December 12, 2023 | |||
 | Vincent Deangelis | 4/25/1994 | vdeangelis4180@gmail.com | +15612683205 | Yes | No | Leave the same, no further action needed | November 14, 2024 | |
 | Leslie Turchon | 8/26/1954 | ellatee@gmail.com | +15615049461 | Yes | No | Leave the same, no further action needed | January 17, 2025 | |
 | Anatoly Martynenko | 3/25/1986 | anatolygunn@gmail.com | +15615469332 | Calm ed me down reduced anxiety helps to sleep increased appetite | No | Leave the same, no further action needed | March 30, 2026 | |
 | Bianca Brodeut | 6/30/1992 | biancabrodeur@icloud.com | +15615709736 | Helps either pain reduces anxiety. Eating disorder and sleep | No | Leave the same, no further action needed | November 12, 2024 | |
 | David Salerno | 5/14/1958 | dsalerno834@gmail.com | +15618469414 | With pain Helps me sleep | No | Leave the same, no further action needed | September 11, 2024 | |
 | Marvin Finklestein | 12/17/1962 | marbin@kripke.com | +15612120028 | Calms me | No | Leave the same, no further action needed | December 23, 2024 | |
 | James Klitzberg | 2/7/1975 | james@klitzberg.com | +15616994395 | Helps my IBS symptons | No | Leave the same, no further action needed | September 23, 2024 | |
 | Gary Malisos | 6/28/1976 | garymalisos@gmail.com | +19545484071 | Alleviates pain and anxiousness | None | Leave the same, no further action needed | December 20, 2024 | |
 | Douglas Nilsen | 1/10/2004 | douglasnilsen@gmail.com | +15619702458 | Relax session me help me sleep | No | Leave the same, no further action needed | December 23, 2024 | |
 | Paula Weiss | 11/6/1975 | paulaweiss75@yahoo.com | +19175750661 | yes and yes. | nope | Leave the same, no further action needed | August 11, 2025 | |
 | Kurt Clark | 2/18/1997 | kjclark1997@gmail.com | +15614005935 | Alleviates stress and migraine pain | No | Leave the same, no further action needed | August 18, 2025 | |
 | Christina Turner | 12/23/1979 | c79t@aol.com | +19542963554 | Relax sleep | No | Leave the same, no further action needed | August 8, 2024 |
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