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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Malcolm Brooks | 3/12/1982 | cam.brooks@gmail.com | +15612512650 | Leave the same, no further action needed | November 2, 2023 | |||
 | Luis Mussi | 10/1/1980 | mylifeoffaith@gmail.com | +14075385766 | Pain management and calms me down | No | Leave the same, no further action needed | August 27, 2024 | |
 | Joseph Lewis | 7/15/1966 | projoe1966@gmail.com | +15613052667 | Relaxeds me sleep lowers anxiety helps sleep | No | Leave the same, no further action needed | September 6, 2024 | |
 | Deven Ali | 11/5/2001 | devenbb83@gmail.com | +15617036738 | yes | no | Leave the same, no further action needed | September 11, 2024 | |
 | Kenneth Vollp | 10/17/1972 | volpp@yahoo.com | +15612844299 | Leave the same, no further action needed | June 13, 2024 | |||
 | Theodore Greenberg | 6/6/1950 | teddy33446@gmail.com | +14432862822 | Relaxes me helps with sleep and pain | No | Leave the same, no further action needed | August 13, 2024 | |
 | Toby Katcher | 1/3/1977 | tobykatcher@yahoo.com | +19174507978 | Alleviates pain, helps sleep, | NA | Leave the same, no further action needed | March 2, 2025 | |
 | Bradley Maged | 1/15/1972 | maged@magedrost.com | +16178187050 | Calms me helps with sleep | No | Leave the same, no further action needed | October 18, 2024 | |
 | Anna Dupras | 2/2/1968 | annadupras@yahoo.com | +15612356300 | Sleep and anxiety | No | Leave the same, no further action needed | January 2, 2025 | |
 | Chris Tzikas | 1/22/1982 | cjtzikas@gmail.com | +15612450594 | Leave the same, no further action needed | October 19, 2023 | |||
 | Antonio Dominguez | 7/20/1994 | alwaystowing305@gmail.com | +17546672479 | Calms me down sleep | None | Leave the same, no further action needed | October 14, 2025 | |
 | Stephanie Marcus | 6/27/1972 | stephbeth627@hotmail.com | +15612219354 | Leave the same, no further action needed | June 10, 2024 | |||
 | Dale Towery | 10/27/1972 | ddt1@hotmail.com | +19546293676 | Leave the same, no further action needed | December 13, 2023 | |||
 | Mark Gordon | 10/29/1955 | markgordon1029@gmail.com | +19143107060 | Relaxes me | No | Leave the same, no further action needed | September 4, 2024 | |
 | Gregg Aronson | 7/17/1980 | gregg.aronson@gmail.com | +16094710644 | Yes | No | Leave the same, no further action needed | October 3, 2024 | |
 | Clayton Noell | 12/13/1991 | cnoell@1050caw.com | +15614144908 | Helps with pain and sleep | No | Leave the same, no further action needed | October 4, 2024 | |
 | Robert Ressler | 8/21/1954 | rbr821@gmail.com | +12185655678 | Helps with stress and uplifts me | No | Leave the same, no further action needed | October 7, 2024 | |
 | Nikki Roth | 2/8/1975 | nikki.roth1111@gmail.com | +15612359711 | Has helped | No | Leave the same, no further action needed | April 7, 2025 | |
 | Karen Moskow | 8/30/1955 | karenkmoskow@me.com | +15617031985 | helps with anxiety | have not | Leave the same, no further action needed | October 1, 2025 | |
 | Alice Klugman | 8/31/1950 | akluggie@gmail.com | +15163569386 | Calms me down takes edge off | No | Leave the same, no further action needed | August 26, 2024 | |
 | Deborah Risley | 5/19/1951 | dndriz@gmail.com | +15617038039 | Leave the same, no further action needed | May 31, 2024 | |||
 | Sheila Buchman | 12/2/1983 | sheilarychlik@gmail.com | +12033213249 | Sleep help calms me down | No | Leave the same, no further action needed | January 16, 2025 | |
 | Kevin Anderson | 5/18/1986 | kevinandersontennis@gmail.com | +18475589733 | Leave the same, no further action needed | October 13, 2023 | |||
 | Hannah Dignoti | 8/1/2000 | hdignoti@yahoo.com | +15612517513 | Yes | No | Leave the same, no further action needed | November 26, 2024 | |
 | Francis Smith | 6/28/1973 | rickynoolesoup@gmail.com | +15613198300 | Leave the same, no further action needed | June 2, 2024 |
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