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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Zachariah Anderson | 9/28/1983 | z_ander77@yahoo.com | +15612511319 | Helps with pain Reduces anxiety Uplifts me | No | Leave the same, no further action needed | October 7, 2024 | |
 | Angela Gondalia | 7/12/1985 | angela.e.linn@gmail.com | +17327702332 | Helps to alleviate pain, helps with sleep, and relaxes my nerves in situation of anxiety, and alleviate muscle tightness | None | Leave the same, no further action needed | August 6, 2024 | |
 | Marianne Wasserman | 6/28/1949 | wasserdog55@yahoo.com | +15617065675 | I only use flower it helps me relax and sleep | No | Leave the same, no further action needed | August 8, 2024 | |
 | Robin Baritz | 11/21/1955 | rbaritz1@gmail.com | +15618667233 | yes | no | Leave the same, no further action needed | November 24, 2024 | |
 | Joseph Baitz | 12/20/1994 | joey_baitz@aol.com | +15617578188 | Calms me down relieves pain | No | Leave the same, no further action needed | July 29, 2025 | |
 | Alex Kudeviz | 1/1/1987 | alexkudeviz@gmail.com | +15613023093 | Yes | No | Leave the same, no further action needed | July 31, 2025 | |
 | Ilan Nieuchowicz | 1/7/1978 | ilan@nukofamily.com | +19544940282 | Leave the same, no further action needed | June 19, 2024 | |||
 | Trevor Whitfield | 1/30/2004 | trevorpw@yahoo.com | +15618085288 | Leave the same, no further action needed | January 5, 2024 | |||
 | Marcelo Souza | 5/21/1980 | mtelless@gmail.com | +14698535844 | Helps with PTSD trauma anxiety and stress | No | Leave the same, no further action needed | December 11, 2024 | |
 | Martin Mcateer | 8/29/1960 | laurenne@comcast.net | +15612133229 | Calms down agitation and anxiety | None | Leave the same, no further action needed | February 20, 2026 | |
 | Eric Sandler | 1/9/1970 | esdakota22@gmail.com | +15613062336 | Pain and anxiety | No | Leave the same, no further action needed | December 30, 2024 | |
 | Jaclyn Finkelstein | 4/29/1999 | jaclyn.finkelstein17@gmail.com | +15618868760 | Relive pain | No | Leave the same, no further action needed | November 7, 2024 | |
 | Kathleen Thiessen | 3/23/1962 | kthiessen62@gmail.com | +15617150680 | Leave the same, no further action needed | February 10, 2024 | |||
 | Martha Alvarez | 12/21/1969 | marthavarela123@gmail.com | +15617029059 | Centers me | No | Leave the same, no further action needed | December 16, 2024 | |
 | Alan Ritz | 4/9/1953 | alanritz@msn.com | +15613023308 | Helps with pain | None | Leave the same, no further action needed | February 16, 2026 | |
 | Jason Brown | 9/8/1975 | jason@foresightcpas.com | +13059032892 | Leave the same, no further action needed | May 2, 2024 | |||
 | Meryl Kowlowitz | 12/2/1970 | bocadognanny@gmail.com | +15612253750 | Relieve hand pain Trigger pain in fingers Upbeats | No | Leave the same, no further action needed | December 13, 2024 | |
 | Mabel Vittini | 2/3/1970 | mabelvittini@gmail.com | +15616018934 | Relieves pain | No | Leave the same, no further action needed | July 1, 2025 | |
 | David Powell | 11/4/1978 | heath@heathpowell.com | +16158150892 | Request Doctor to contact me to make changes | February 29, 2024 | |||
 | Jeremy Torres | 6/24/1988 | jtorresallday365@gmail.com | +19549971346 | Calms you down | No | Leave the same, no further action needed | February 9, 2026 | |
 | John Lovecchio | 9/21/1983 | jjlove26@gmail.com | +15619399722 | Sleep and calms me down helps with neuropathy | None | Leave the same, no further action needed | November 15, 2024 | |
 | Rebecca Kleinberg | 2/24/1974 | r.kleinberg74@gmail.com | +15613225162 | Helps with pain and relaxes me stops eye twitches and arthritis | No | Leave the same, no further action needed | October 26, 2024 | |
 | robin friedman | 10/8/1957 | robinfriedman08@gmail.com | +15612511171 | Leave the same, no further action needed | October 5, 2023 | |||
 | Michael Amoriello | 3/23/1988 | illadelph42@mac.com | +15617165829 | Request Doctor to contact me to make changes | July 8, 2024 | |||
 | lori weinstein | 2/21/1977 | loriweinstein@gmail.com | +16463193596 | It has helped calm my immune system so i have less severe reactions. | No | Leave the same, no further action needed | July 19, 2024 |
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