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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Richard Karson | 1/10/1954 | richard.karson@gmail.com | +15163823076 | Leave the same, no further action needed | May 1, 2024 | |||
 | Justin Weissfield | 6/1/1975 | jweissfield@gmail.com | +19547787221 | Leave the same, no further action needed | May 3, 2024 | |||
 | Lana Almasri | 10/30/1998 | lanaalmasri@yahoo.com | +15868720535 | Leave the same, no further action needed | May 6, 2024 | |||
 | Daniel Markarian | 3/5/1963 | markariandaniel@gmail.com | +15619514144 | Request Doctor to contact me to make changes | May 6, 2024 | |||
 | Vincent Deangelis | 4/25/1994 | vdeangelis4180@gmail.com | +15612683205 | Leave the same, no further action needed | May 8, 2024 | |||
 | Earl Sands | 5/21/1963 | michealsands9mm@gmail.com | +19544059108 | Leave the same, no further action needed | May 8, 2024 | |||
 | William Stover | 12/9/1953 | wfarfalla@aol.com | +15619454818 | Leave the same, no further action needed | May 13, 2024 | |||
 | William Stover | 12/9/1953 | wfarfalla@aol.com | +15619454818 | Leave the same, no further action needed | May 13, 2024 | |||
 | Fred Silberstein | 3/10/1971 | fred@sfpadvisors.com | +19546292084 | Leave the same, no further action needed | May 17, 2024 | |||
 | Marcelo Souzs | 5/21/1980 | mtelless@gmail.com | +14698535044 | Leave the same, no further action needed | May 18, 2024 | |||
 | Kelly Dellovo | 11/3/1970 | vkdellovo@aol.com | +15614146781 | Leave the same, no further action needed | May 20, 2024 | |||
 | Kevin Anderson | 5/18/1986 | kevinandersontennis@gmail.com | +18475589733 | Request Doctor to contact me to make changes | May 21, 2024 | |||
 | Tiffany Williamson | 10/6/1998 | tiffanywilliamson@outlook.com | +15617064405 | Leave the same, no further action needed | May 22, 2024 | |||
 | Tiffany Williamson | 10/6/1998 | tiffanyxwilliamson@outlook.com | +15617064405 | Leave the same, no further action needed | May 23, 2024 | |||
 | Michael Sholl | 6/19/1952 | shollmichael10@gmail.com | +15613051223 | Leave the same, no further action needed | May 23, 2024 | |||
 | Paul Beaulieu | 12/20/1981 | pb122081@gmail.com | +15619710644 | Request Doctor to contact me to make changes | May 23, 2024 | |||
 | Michael Checo | 12/31/1999 | mchevo123@gmsil.com | +15618438338 | Leave the same, no further action needed | May 28, 2024 | |||
 | Marvin A Finkelstein | 12/17/1962 | marvin@kripke.com | +15612120028 | Leave the same, no further action needed | May 29, 2024 | |||
 | Daniel Johnson | 1/17/1994 | danieldjohnson94@gmail.com | +19548924110 | Leave the same, no further action needed | May 31, 2024 | |||
 | Gerald Martin | 6/10/1964 | geraldmartinez513@gmail.com | +15619953773 | Leave the same, no further action needed | June 1, 2024 | |||
 | Angela Thompson | 3/8/1981 | angelaallen123@yahoo.com | +15618172315 | Leave the same, no further action needed | June 3, 2024 | |||
 | Lance Lewis | 11/23/1976 | lancethan@yahoo.com | +17543049451 | Leave the same, no further action needed | June 4, 2024 | |||
 | Judith Jacobs | 12/7/1956 | dancejj111@aol.com | +15617194250 | Leave the same, no further action needed | June 10, 2024 | |||
 | Montse Fontanot | 2/16/2000 | montsefontanot@icloud.com | +15617579923 | Leave the same, no further action needed | June 10, 2024 | |||
 | Leslie Turchon | 8/26/1954 | ellatee@gmail.com | +15615049461 | Leave the same, no further action needed | June 10, 2024 |
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