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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Scott Lang | 8/22/1996 | scottlang@bellsouth.net | +19545574068 | Leave the same, no further action needed | April 2, 2024 | |||
 | Kenneth Dale | 7/9/1950 | kdale1950@gmail.com | +17817711976 | Leave the same, no further action needed | April 3, 2024 | |||
 | STEPHANIE PARKER | 12/18/1968 | stephanieleeparker@gmail.com | +19544617331 | Leave the same, no further action needed | April 5, 2024 | |||
 | Arthur Wozniak | 7/18/1954 | arthurwozniak33@gmail.com | +15619296005 | Leave the same, no further action needed | April 5, 2024 | |||
 | Alexie Lawler | 9/8/1970 | lexielaww@gmail.com | +15616992674 | Leave the same, no further action needed,Request Doctor to contact me to make changes | April 8, 2024 | |||
 | Rebecca Kleinberg | 2/2/1974 | r.kleinberg74@gmail.com | +15613225162 | Request Doctor to contact me to make changes | April 10, 2024 | |||
 | Milagros Falero | 5/9/1972 | tdavila369@gmail.com | +15619399875 | Request Doctor to contact me to make changes | April 10, 2024 | |||
 | Louis Irizarry | 4/23/1966 | louis.irizarry@icloud.com | +13057988555 | Leave the same, no further action needed | April 11, 2024 | |||
 | Laura Winston | 9/13/1962 | laurafromfl@yahoo.com | +15613864743 | Leave the same, no further action needed | April 11, 2024 | |||
 | Erica Sabo | 2/11/1971 | erica.sabo@hotmail.com | +14072579769 | Leave the same, no further action needed | April 12, 2024 | |||
 | Jill Morris | 9/15/1965 | jmorrisphd@yahoo.com | +15617020592 | Leave the same, no further action needed | April 15, 2024 | |||
 | Jodi Miller | 2/13/1974 | jodimiller@gmail.com | +15618431376 | Leave the same, no further action needed | April 16, 2024 | |||
 | Jack Serendensky | 8/7/1957 | pat_jake1964@yahoo.com | +19542457668 | Leave the same, no further action needed | April 16, 2024 | |||
 | Pablo Solorzano cohen | 9/10/1977 | psolorzano@gmail.com | +13106213509 | Leave the same, no further action needed | April 16, 2024 | |||
 | Rebecca Garver | 2/10/1962 | kbellaluna@verizon.net | +14124919215 | Leave the same, no further action needed | April 17, 2024 | |||
 | Angela Greenspan | 4/21/1989 | anggreenspan@gmail.com | +17324915409 | Leave the same, no further action needed | April 19, 2024 | |||
 | Lisa Pottheiser | 5/10/1966 | lpottheiser@gmail.com | +19173328860 | Leave the same, no further action needed | April 22, 2024 | |||
 | Lisa Pottheiser | 5/10/1966 | lpottheiser@gmail.com | +19173328860 | Leave the same, no further action needed | April 22, 2024 | |||
 | Lisa Pottheiser | 5/10/1966 | lpottheiser@gmail.com | +19173328860 | Leave the same, no further action needed | April 22, 2024 | |||
 | Amanda King | 5/24/1992 | a.herron.1992@gmail.com | +19895132630 | Leave the same, no further action needed | April 22, 2024 | |||
 | Amanda King | 5/24/1992 | a.herron.1992@gmail.com | +19895132630 | Leave the same, no further action needed | April 22, 2024 | |||
 | Stacey Nitkowski | 4/14/1975 | sbnitkowski@yahoo.com | +15617676704 | Leave the same, no further action needed | April 24, 2024 | |||
 | Taylor Sweet | 4/1/1999 | rusweet99@hotmail.com | +19548260598 | Leave the same, no further action needed | April 25, 2024 | |||
 | Chaim Nissel | 12/12/1983 | cnissel100@gmail.com | +17189094124 | Leave the same, no further action needed | April 28, 2024 | |||
 | Victoria Robelo | 2/10/1961 | victoriaerobo@gmail.com | +17862088480 | Leave the same, no further action needed | April 29, 2024 |
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