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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Paul Beaulieu | 12/20/1981 | pb122081@gmail.com | +15619710644 | Pain relief and calms me | No | Leave the same, no further action needed | December 17, 2024 | |
 | Dillon Botich | 9/17/1990 | dillonbotich@yahoo.com | +16029890801 | I have been able to get out of the house more | No | Request Doctor to contact me to make changes | December 16, 2024 | |
 | Earl Sands | 5/21/1963 | michaelsands9mm@gmail.com | +19544059108 | Helps with pain | No | Leave the same, no further action needed | December 12, 2024 | |
 | Kenneth Dale | 7/9/1950 | kdale1950@gmail.com | +17817711976 | Relaxes me helps with pain and anxiety | No | Leave the same, no further action needed | December 11, 2024 | |
 | Olivia Rothberg | 9/27/1994 | orothberg27@gmail.com | +19144629619 | Relaxes me helps sleep increases appetite | No | Leave the same, no further action needed | November 4, 2024 | |
 | Kelly Roosevelt | 7/9/1958 | kellyroosevelt2@aol.com | +15615126892 | Very beneficial. | Never have | Leave the same, no further action needed | June 10, 2025 | |
 | Carolina Escobar | 9/27/1960 | c_escobar1@hotmail.com | +15612451084 | reduces stress helps with sleep | no | Leave the same, no further action needed | May 9, 2024 | |
 | Karen Rudolf | 4/27/1966 | savvylaw@icloud.com | +15615951390 | Helps alot | No | Leave the same, no further action needed | June 4, 2025 | |
 | Erica Seplow | 2/22/1982 | partyplanner222@aol.com | +15163843925 | Yes, it helps me relax and stops My anxious thoughts. It also gives me Motivation to get things done | No | Leave the same, no further action needed | September 15, 2024 | |
 | William Stover | 12/9/1953 | wfarfalla@aol.com | +15619454818 | Helps with sleep and anxiety | No | Leave the same, no further action needed | December 2, 2024 | |
 | Kristin Pease | 9/29/1979 | kpkleinhans@gmail.com | +15617036963 | I have experienced functional improvements with the use of my hands during rheumatoid arthritis flares. | No | Leave the same, no further action needed | September 12, 2024 | |
 | Joey Silverstein | 7/13/2005 | joeysilverstein@aol.com | +15615630125 | Calms anxiety sleep through night | No | Leave the same, no further action needed | November 25, 2024 | |
 | Christi Parsons | 1/26/1982 | christi.parsons82@gmail.com | +15614517522 | Yes | No | Request Doctor to contact me to make changes | November 25, 2024 | |
 | Arthur Wozniak | 7/18/1954 | arthurwozniak34@gmail.com | +15619296005 | Helps with pain and anxiety | No | Leave the same, no further action needed | November 19, 2024 | |
 | Lawrence Martino | 1/13/1947 | lpmartino@yahoo.com | +14048867398 | Helps with pain uplifts my depression calms my anxiety | No | Leave the same, no further action needed | November 20, 2024 | |
 | Mitchell Halem | 2/13/1961 | mitch@builtbyhas.com | +13017502625 | Alleviates pain | None | Leave the same, no further action needed | November 19, 2024 | |
 | Jonathan Friedman | 3/4/1979 | jonathanjournalism@gmail.com | +13109855255 | alot better | i have not | Leave the same, no further action needed | May 14, 2025 | |
 | Debra Rosen | 9/14/1954 | debra.rosen1@gmail.com | +16103903481 | Sleep reduces anxiety and helps with pain | No | Leave the same, no further action needed | November 8, 2024 | |
 | Leandra Peterson | 7/7/1987 | leandrapeterson7@gmail.com | +15617033458 | Helps with pain | No | Leave the same, no further action needed | May 8, 2025 | |
 | Daryl Decuir | 2/12/1957 | daryldecuir@yahoo.com | +16193585775 | Helps with pain And anxiety | No | Leave the same, no further action needed | October 15, 2024 | |
 | Elizabeth Maschler | 10/13/1953 | liz@maschler.com | +15614454554 | Calms me down | No | Leave the same, no further action needed | May 7, 2025 | |
 | Stacy Santoloci | 2/28/1970 | stacy.santoloci@gmail.com | +19544943309 | Leave the same, no further action needed | April 12, 2024 | |||
 | Venetia Tully | 9/25/1969 | veech47@gmail.com | +15614798171 | Relaxes me calms me | No | Leave the same, no further action needed | October 23, 2024 | |
 | Jodi Miller | 2/13/1974 | jodimiller@gmail.com | +15618431376 | It helps me to stay relaxed and to sleep better. It also helps with perimenopause symptoms of anxiety and sleeplessness. | No | Leave the same, no further action needed | May 2, 2025 | |
 | Stephanie Parker | 12/18/1968 | stephanieleeparker@gmail.com | +19544617331 | I have less anxiety. I’m able to relax and sleep better With an overall sense of well-being. I Observed improvement. | No | Leave the same, no further action needed | November 1, 2024 |
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