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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Quentin Cooper | 3/11/1986 | russriot@yahoo.com | +15202358385 | Calms me helps with back pain | No | Leave the same, no further action needed | July 8, 2025 | |
 | Jeffrey Govberg | 1/14/1962 | jeffreygovberg@gmail.com | +16102121164 | Pain and anxiety | No | Leave the same, no further action needed | July 8, 2025 | |
 | Charles Capp | 5/31/1970 | charbcapp@yahoo.com | +14707215388 | Calms me relaxes me uplifts me | No | Leave the same, no further action needed | January 7, 2025 | |
 | Jordan Jackson | 11/6/1998 | jjacksonprime5@gmail.com | +15615962439 | PTSD sufferer. Marijuana has helped tremendously with this. | No | Leave the same, no further action needed | January 8, 2025 | |
 | Guy Gelinas JR | 9/24/1985 | ggelinas38@gmail.com | +15614278909 | Relaxes me | None | Leave the same, no further action needed | January 10, 2025 | |
 | Hannah Kass | 12/17/1959 | hannhim@hotmail.com | +17326142553 | helps alot | none | Leave the same, no further action needed | July 5, 2025 | |
 | Dean Schneider | 6/14/1953 | dotherb22@gmail.com | +18137666677 | Leave the same, no further action needed | September 28, 2023 | |||
 | Lisa McCusker | 9/28/1955 | lisawmccusker@gmail.com | +15615048559 | Helps with pain and sleep | No | Leave the same, no further action needed | February 19, 2025 | |
 | Harlan Kilstein | 9/22/1957 | rebtsvi@gmail.com | +15617065557 | Yes | No | Leave the same, no further action needed | December 30, 2024 | |
 | Janine Rocca | 5/16/1981 | janinerocca@yahoo.com | +19416852712 | Helps me with pain and muscle spasms | No | Leave the same, no further action needed | December 31, 2024 | |
 | Andrew Wilbur | 1/5/1990 | 561dreww@gmail.com | +15613740713 | Alleviates pain and anxiety | No | Leave the same, no further action needed | December 26, 2024 | |
 | Robert Muir | 4/7/1981 | robertclarkmuir@yahoo.com | +15612980420 | Pain relief relaxes me | No | Leave the same, no further action needed | December 26, 2024 | |
 | Eunice Rucker | 9/14/1951 | eunice091340@gmail.com | +19546218706 | Pain and anxiety relief | No | Leave the same, no further action needed | December 26, 2024 | |
 | Melodye Martin | 6/17/1951 | melodye.martin@gmail.com | +15617067528 | Leave the same, no further action needed | January 23, 2024 | |||
 | Michael Dombrowsky | 3/7/1955 | mikedombrowsky@bellsouth.net | +15616286642 | Pain relief | No | Leave the same, no further action needed | November 21, 2024 | |
 | Nina Alter | 7/7/1944 | joyofmusic@gmail.com | +15614456774 | Relieves eye pressure and anxiety | No | Leave the same, no further action needed | December 19, 2024 | |
 | Virginia Cordero | 5/6/1966 | cordero.virginia1966@gmail.com | +15615983398 | Relaxes and helps sleep | No | Leave the same, no further action needed | December 16, 2024 | |
 | Sean Marconis | 7/18/1987 | justsean718@gmail.com | +15614414399 | Sleeping and anxiety relief | No | Leave the same, no further action needed | December 16, 2024 | |
 | Alyse Smith | 1/2/1990 | alyseksmith@gmail.com | +16092765892 | Keeps me focused and reduces anxiety | No | Leave the same, no further action needed | October 29, 2024 | |
 | Irving Goldfarb | 10/13/1953 | agold13@me.com | +19548686051 | Less pain. Yes on functional improvement | No | Request Doctor to contact me to make changes | December 12, 2024 | |
 | Augusto Lizarazo | 7/30/1970 | a_lizarazo@yahoo.com | +15618662427 | I am also a tennis coach, and arthritis, which developed due to my HIV as an opportunistic disease, hinders my performance as a coach. Marijuana helps me feel loose and recover my mobility. | No | Leave the same, no further action needed | December 12, 2024 | |
 | Megan Pastore | 10/8/1982 | meganpastore@gmail.com | +15612325566 | Helps reduce anxiety and aides sleep | No | Leave the same, no further action needed | June 12, 2025 | |
 | Lisa Spitzer | 9/10/1951 | lisaspitzer@yahoo.com | +15619619941 | Leave the same, no further action needed | December 5, 2023 | |||
 | Lisa Spitzer | 9/10/1951 | lawyerrefferalservice@yahoo.com | +15619619941 | Leave the same, no further action needed | June 11, 2024 | |||
 | Nicholas Cassandra | 10/29/1994 | ncassandra@cassandraebg.com | +15618476382 | Helps with pain | No | Leave the same, no further action needed | November 8, 2024 |
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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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