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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Jacqueline Nelson | 12/4/1979 | jackiea1204@yahoo.com | +15619850673 | Relaxes me lets me sleep | None | Leave the same, no further action needed | November 1, 2024 | |
 | Alex Shlamowitz | 2/28/1997 | alexshlamowitz@gmail.com | +15617973211 | Reduces Anxiety Uplifts me | No | Leave the same, no further action needed | September 27, 2024 | |
 | Nicholas Schmidt | 8/14/1999 | nickschmidt98@yahoo.com | +15619357556 | Noticed remarkable relief for my anxiety and sleeping issues | Not that I know of | Leave the same, no further action needed | September 27, 2024 | |
 | Lori Grube | 5/31/1971 | mrslorigrube@gmail.com | +19176261723 | Fights my anxiety from PTSD and helps with pain | No | Leave the same, no further action needed | October 29, 2024 | |
 | Carol Gulino | 1/20/1947 | cargul29@yahoo.com | +19543032946 | improved. yes. | no, never. | Leave the same, no further action needed | April 28, 2025 | |
 | Richard Deien | 7/1/1981 | rad3427@gmail.com | +15612359703 | yes, calms me down. Very improved. | No negatives | Leave the same, no further action needed | April 28, 2025 | |
 | robert Furtick | 5/20/1976 | robertfurtick@gmail.com | +15613225232 | stay focused, reduces anxiety, stops intrusive thoughts | no | Leave the same, no further action needed | September 23, 2024 | |
 | Sean Stevens | 6/28/1982 | sean-stevens@live.com | +15613507986 | It has allowed me to sleep and relax at night without having to take prescription sleeping pills. Has helped with depressive episodes to feel more relaxed and happy and quicker to come out of those episodes. | No | Leave the same, no further action needed | October 28, 2024 | |
 | Carlos Almodovar | 1/1/1969 | pichimanuel0101@gmail.com | +19547366534 | Helps with pain | No | Leave the same, no further action needed | September 30, 2024 | |
 | Kathleen Mills | 7/23/1957 | kathleenmills57@gmail.com | +15616640361 | Relieves pain makes me calm stopped colloid | No | Leave the same, no further action needed | October 21, 2024 | |
 | Karin Lawrence | 4/17/1984 | kkbkc@aol.com | +15614656168 | Reduces anxiety | No | Leave the same, no further action needed | October 22, 2024 | |
 | sam lerner | 10/26/1951 | sam1iam@aol.com | +19542954403 | sleep better and eat better | no | Leave the same, no further action needed | October 23, 2024 | |
 | Richard Salit | 6/15/1955 | richardsalit@gmail.com | +19544444479 | Helps sleep helps with anxiety | None | Leave the same, no further action needed | October 17, 2024 | |
 | Jimmy Jalil | 7/11/1977 | jrjalil77@aol.com | +15612510943 | yes | no | Leave the same, no further action needed | October 21, 2024 | |
 | Sally Cortes | 9/13/1962 | unigirl444@aol.com | +19176514132 | Yes helps me with pain and sleep | Never | Leave the same, no further action needed | April 21, 2025 | |
 | Lateefah Morse | 12/6/1991 | morsele21@gmail.com | +15037892862 | My symptoms have been alleviated and it has helped with my anxiety. | None | Leave the same, no further action needed | October 21, 2024 | |
 | Jessica Francese | 2/25/1944 | adela33431@gmail.com | +15614415709 | Helps pain and nausea and sleeping | No | Leave the same, no further action needed | October 16, 2024 | |
 | Milagros Falero | 5/9/1972 | tdavila369@gmail.com | +15619399875 | Relaxes me takes the edge off | No | Leave the same, no further action needed | October 21, 2024 | |
 | Pablo Solorzano Cohen | 9/10/1977 | psolorzano@gmail.com | +13106213509 | Helps my anxiety | No | Leave the same, no further action needed | October 17, 2024 | |
 | Kathleen Kolehma | 9/9/1999 | katie.kolehma@gmail.com | +19546511226 | Medical marijuana has helped my anxiety and sleep tremendously. I feel so much happier and able to calm down. | No | Leave the same, no further action needed | October 14, 2024 | |
 | Jessica Lang | 3/9/1979 | jessicalanghhp@gmail.com | +17817044934 | Alleviates pain and anxiety | None | Leave the same, no further action needed | April 14, 2025 | |
 | Ellyn Osher | 2/22/1952 | ellyno@gmail.com | +18476246200 | Help with anxiety and sleeping | No | Leave the same, no further action needed | October 11, 2024 | |
 | Joseph Rossi | 11/27/1985 | joerossi23x@yahoo.com | +15613867797 | Helps all around. | No side effects. | Leave the same, no further action needed | October 9, 2024 | |
 | Steven Crane | 9/13/1963 | drscrane1@gmail.com | +19545888943 | Leave the same, no further action needed | June 30, 2024 | |||
 | Rebecca Garver | 2/10/1962 | kbellaluna@verizon.net | +14124919215 | Alleviates pain Combats anxiety | No | Leave the same, no further action needed | November 11, 2024 |
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