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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Tamar Klopfer | 11/23/2003 | tamarklopfer7@gmail.com | +13055907774 | Yes | No | Leave the same, no further action needed | June 10, 2025 | |
 | Philip Harty | 6/9/1967 | phillip_harty@yahoo.com | +19545597681 | Yes I did | No I haven’t | Leave the same, no further action needed | December 9, 2024 | |
 | Alexandro Dos Santos | 3/11/1973 | gaetealex@yahoo.com | +15614517189 | Pain relief calms me | No | Request Doctor to contact me to make changes | December 4, 2024 | |
 | Michele LoMonte-McCarrick | 7/12/1980 | miowtc@aol.com | +19546559242 | Yes | No | Leave the same, no further action needed | May 25, 2025 | |
 | Dalton Vieitas | 7/5/1980 | daltonvieitas@gmail.com | +15616760055 | Yes much better sleep and less anxiety | No | Leave the same, no further action needed | October 10, 2024 | |
 | Zachary Koehler | 7/11/2001 | zachary.koehler@icloud.com | +19542798799 | Calms me helps me sleep | No | Leave the same, no further action needed | November 18, 2024 | |
 | Louis Stadfeld | 3/20/1951 | lss@franchise-counsel.com | +17814444883 | helps alot | i havent | Leave the same, no further action needed | May 13, 2025 | |
 | Dwuayra Thomas | 7/20/1999 | dwuayrathas0711@yahoo.com | +15618083043 | yes helps alot | none | Leave the same, no further action needed | May 9, 2025 | |
 | Melissa Baer | 4/4/1980 | melissa_baer@yahoo.com | +15617157736 | Relaxes me | No | Leave the same, no further action needed | May 8, 2025 | |
 | Brent Joy | 3/17/1963 | brentjoy@gmail.com | +17274804127 | Yes. It has helped greatly. | No | Leave the same, no further action needed | November 6, 2024 | |
 | Austin Faulk | 12/31/1993 | austin_faulk@icloud.com | +19542580884 | Yes | No | Leave the same, no further action needed | November 4, 2024 | |
 | Greta Cordon | 5/16/1977 | maxwellwims80@gmail.com | +15613743875 | Relaxes me helps with back pain | No | Leave the same, no further action needed | May 5, 2025 | |
 | Michael Nasiff | 2/7/1986 | michaelnasiff@gmail.com | +15618068939 | Reduces anxiety connects me to spirit world opens up my pineal glade | No | Leave the same, no further action needed | December 3, 2024 | |
 | Craig Sawyer | 3/29/1961 | c.sawyer65@yahoo.com | +17729131347 | Pain relief anxiety relief | No | Leave the same, no further action needed | November 26, 2024 | |
 | Erica Ansley | 4/14/1983 | ericahp@outlook.com | +19546583747 | Helps with pain Balances me | No | Leave the same, no further action needed | September 30, 2024 | |
 | Pearl Morris | 11/25/1963 | lemonlicker1962@aol.com | +19546571060 | Helps with appetite Helps with pain Helps with nausea | No | Leave the same, no further action needed | October 31, 2024 | |
 | Vivian Mendes | 1/29/1983 | vivianfl22@hotmail.com | +19546759822 | helps with anxiety | no negatives so far | Leave the same, no further action needed | April 30, 2025 | |
 | Jeffrey Smiley | 8/1/1957 | jsmiley721@gmail.com | +12404018851 | Helps with pain and anxiety | No | Leave the same, no further action needed | October 24, 2024 | |
 | Jacek Wohl | 6/15/1976 | jacekwohl@gmail.com | +15618064238 | With pain relaxes me | No | Leave the same, no further action needed | October 21, 2024 | |
 | Alexis Lawler | 9/8/1970 | lexielaww@gmail.com | +15616992674 | It allows me to fall asleep despite severe insomnia | None | Leave the same, no further action needed | October 22, 2024 | |
 | Barry Pugatch | 9/8/1945 | bpugatch@pugatch.com | +15164581624 | Relieves pain | No | Leave the same, no further action needed | October 21, 2024 | |
 | Fabianna Van Oordt | 5/21/2001 | fabianna0521@hotmail.com | +15615775193 | Calms her down helps sleep | No | Leave the same, no further action needed | October 16, 2024 | |
 | Janice Dowling | 2/1/1953 | mr_daniel_dowling@email.com | +15617046631 | Haven’t used | No | Leave the same, no further action needed | September 5, 2024 | |
 | Joshua Miller | 3/22/2002 | josh7025250@gmail.com | +15617025250 | Helps with inflammation and pain | No | Leave the same, no further action needed | October 17, 2024 | |
 | Brenda Blaustein | 8/11/1949 | newyorkbrenda@gmail.com | +19174461964 | Request Doctor to contact me to make changes | April 18, 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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