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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Emily Hartstone | 11/13/1985 | hartstone.emily@gmail.com | +18606044622 | Helps with pain | No | Leave the same, no further action needed | December 2, 2025 | |
 | Kyle Schwartz | 11/18/1998 | kylegschwartz@gmail.com | +15165674762 | Relaxation helps with social anxiety Helps me sleep | No | Request Doctor to contact me to make changes | August 2, 2024 | |
 | Sean Boland | 1/5/2004 | seanboland1504@gmail.com | +18132304940 | Reduces anxiety Sleep improvement Helps with depression | No | Request Doctor to contact me to make changes | September 23, 2024 | |
 | Shawn Sichenzio | 11/13/1968 | shawnbno.5@verizon.net | +19082950465 | Helps with pain and anxiety | None | Leave the same, no further action needed | November 24, 2025 | |
 | Robert Jackson | 12/24/1964 | rib.fishnyc@gmail.com | +16468247951 | Pain relief anxiety reducing helps with nausea | No | Leave the same, no further action needed | March 6, 2025 | |
 | Billy Erskine | 12/20/1977 | erskineowl@gmail.com | +18635999445 | Leave the same, no further action needed | December 22, 2023 | |||
 | Marcie Falb | 3/2/1952 | marciefalb@gmail.com | +19545920688 | Leave the same, no further action needed | February 16, 2024 | |||
 | Roxanne Pacheco | 4/11/1985 | roxpacheco85@gmail.com | +15612914277 | Helps sleep | No | Leave the same, no further action needed | November 15, 2025 | |
 | Mary Day | 4/2/1963 | mcday96@yahoo.com | +19782700527 | Relaxes me | No | Leave the same, no further action needed | March 11, 2025 | |
 | Daniel Encarnacion | 1/27/1993 | danielj0213@gmail.com | +19543099549 | Helps with pain depression and anxiety | No | Leave the same, no further action needed | November 4, 2025 | |
 | Fred Silberstein | 3/10/1971 | fred@sfpadvisors.com | +19546292084 | Helps with IBS symptoms and arthritic pain | No | Leave the same, no further action needed | November 4, 2025 | |
 | Michael Miller | 12/22/1946 | drmiller_98@yahoo.com | +16464304617 | Helps with pain. Uplifts me while I am depressed | Yes Vape pens burns my throat actual flower does not | Leave the same, no further action needed | September 23, 2024 | |
 | Gabrielle Lasure | 1/29/2002 | yorkiebeak@gmail.com | +17726437898 | Relaxes me | No | Leave the same, no further action needed | September 9, 2024 | |
 | Lauren Hennick | 5/8/1975 | laurenhennick7@gmail.com | +15616545888 | Calms me down | No | Leave the same, no further action needed | February 24, 2025 | |
 | REYNALDO SERRANO | 10/1/1959 | cbsmommy@comcast.net | +15613290051 | It helped me feel relaxed and able to sleep at night. | no | Leave the same, no further action needed | October 28, 2025 | |
 | Lee Yaffe | 5/15/1965 | leeyaffe45@gmail.com | +16173201110 | Sleep and relaxes me | No | Leave the same, no further action needed | August 30, 2024 | |
 | Ian Harris | 4/3/1998 | ianalexharris@gmail.com | +16179993406 | Calms me down allows focus | No | Leave the same, no further action needed | October 28, 2025 | |
 | Francine Gindi | 1/21/1950 | fgindi12@gmail.com | +17202065157 | Leave the same, no further action needed | January 2, 2024 | |||
 | Stephen Scott | 3/13/1969 | stephenhscottpiano@gmail.com | +19293168162 | I have less stress and less pain. | NO | Leave the same, no further action needed | September 30, 2024 | |
 | Joan Cruz | 5/5/1944 | joansgrove@gmail.com | +19174534157 | Leave the same, no further action needed | January 3, 2024 | |||
 | Angela Yurchuck | 8/8/1970 | chuckie7311@comcast.net | +19544488621 | Alleviates anxiety and pain | No | Leave the same, no further action needed | October 13, 2025 | |
 | Christopher MILLER | 11/7/1994 | cmilllerr@gmail.com | +19548123021 | Leave the same, no further action needed | January 15, 2024 | |||
 | Keith Brock | 6/26/1982 | kbrock625@gmail.com | +13053087029 | Calms me down | No | Leave the same, no further action needed | October 6, 2025 | |
 | Dominick Forte | 2/6/1957 | djforte1@gmail.com | +15614250284 | Relaxed relieves joint pain pain in head from nose | No | Request Doctor to contact me to make changes | July 19, 2024 | |
 | Neda Vanden Bosch | 5/25/1967 | nedavbosch@hotmail.com | +15616022216 | Helps with pain and sleep | No | Leave the same, no further action needed | February 18, 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 |
|---|---|---|---|---|---|---|---|---|---|
 | 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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