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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Glen Huff | 6/18/1970 | enviroac@aol.com | +19547086125 | Leave the same, no further action needed | June 11, 2024 | |||
 | Anthony Digiacomo | 8/13/1951 | opensky15us@gmail.com | +15612135650 | Pain | No | Leave the same, no further action needed | December 27, 2024 | |
 | Janie Barrett | 11/12/1994 | janieabarrett@gmail.com | +15613851806 | Helps me eat food to gain weight Anxiety | No | Leave the same, no further action needed,Request Doctor to contact me to make changes | August 25, 2025 | |
 | Frank Vendola IV | 4/11/2002 | vendola4@gmail.com | +15618161036 | Calms me | No | Leave the same, no further action needed | August 21, 2025 | |
 | David Tripp | 8/3/1969 | dctripp@msn.com | +19544398203 | Relaxes me | No | Leave the same, no further action needed | January 23, 2025 | |
 | Steven Getsoff | 8/14/1949 | stevengetsoff16@gmail.com | +15617205683 | Helps either pain calms nerves | No | Leave the same, no further action needed | July 15, 2025 | |
 | Michael Laufer | 1/28/1977 | mike@recruithook.com | +18453139072 | Alleviates pain helps with anxiety from pain | No | Request Doctor to contact me to make changes | December 5, 2024 | |
 | Jack Frost | 1/4/1955 | jack_fro@msn.com | +19544643884 | Pain relief | No | Leave the same, no further action needed | November 26, 2024 | |
 | Anessa Cwiklinski | 4/17/2000 | anessacwik@gmail.com | +13178282565 | Yes | No | Leave the same, no further action needed | July 13, 2025 | |
 | Gwen Wolf | 2/25/1953 | gwolf56224@hotmail.com | +15617161679 | Sleep pain and anxiety relief | None | Leave the same, no further action needed | January 27, 2025 | |
 | Paul Tatasciore | 1/16/1991 | paultat91@gmail.com | +19548642984 | Leave the same, no further action needed | June 11, 2024 | |||
 | Jason MacMurray | 6/2/1978 | jaymam78@yahoo.com | +15165065448 | Leave the same, no further action needed | July 6, 2024 | |||
 | Steven Kerley | 1/30/1976 | skerley222@gmail.com | +15619261310 | Yes, it helps alleviate the pain in my knees and wrists | No | Leave the same, no further action needed | January 17, 2025 | |
 | Susan Wallace | 10/30/1955 | cmw001@comcast.net | +15612514441 | Calms me down helps with sleep restless legs syndrome | No | Leave the same, no further action needed | July 9, 2025 | |
 | Angela Greenspan | 4/21/1989 | anggreenspan@gmail.com | +17324915409 | Relaxes me | No | Leave the same, no further action needed | January 6, 2025 | |
 | Betsy Devecchis | 7/17/1992 | byunk92@yahoo.com | +15613025483 | Alleviates migraines and anxiety | No | Leave the same, no further action needed | January 6, 2025 | |
 | Samuel McAllister | 5/12/2003 | sammcallister512@gmail.com | +19544158094 | Helps with pain | No | Request Doctor to contact me to make changes | January 9, 2025 | |
 | Paola Fontanot | 2/16/2000 | montsefontanot@icloud.com | +15617579923 | Calms me down Nightmares alleviated | No | Leave the same, no further action needed | January 2, 2025 | |
 | Flavia Hendrickson | 8/13/1977 | flavia.hendrickson@gmail.com | +15612891748 | Decreases pain Increase sleep | No | Leave the same, no further action needed | December 30, 2024 | |
 | Amanda King | 5/24/1992 | a.herron1992@gmail.com | +19895132630 | Pain anxiety stomach pains | No | Leave the same, no further action needed | November 26, 2024 | |
 | Kelley Dellovo | 11/3/1970 | vkdellovo@aol.com | +15614146781 | Calms me down | No | Leave the same, no further action needed | December 13, 2024 | |
 | Michael Sholl | 6/19/1952 | shollmichael10@gmail.com | +15613051223 | Pain relief reduces anxiety | None | Request Doctor to contact me to make changes | December 18, 2024 | |
 | Deirdre Lachner | 12/4/1968 | dlachner@comcast.net | +17703569992 | Yes, use of marijuana has greatly improved my insomnia and also eased my anxiety. | no | Leave the same, no further action needed | December 20, 2024 | |
 | Michelle Dunaway | 11/27/1962 | spotspotcat@comcast.net | +15618665213 | It has helped with my insomnia and social anxiety as well as hip arthritis pain. | No | Leave the same, no further action needed | December 20, 2024 | |
 | Gerald Martinez | 6/10/1964 | geraldmartinez513@gmail.com | +15619953773 | Pain relief uplifts mood | No | Request Doctor to contact me to make changes | December 20, 2024 |
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