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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 |
|---|---|---|---|---|---|---|---|---|---|
 | Geoffrey Carmichael | 11/27/1982 | scsteel9210@gmail.com | +15617670868 | Yes , functional | Never | Leave the same, no further action needed | August 12, 2024 | |
 | Alexandra Kienle | 2/23/1969 | alexkienle69@gmail.com | +15615735587 | Leave the same, no further action needed | February 5, 2024 | |||
 | Robert Ross | 6/30/1983 | rssbobby@gmail.com | +15615041335 | Leave the same, no further action needed | October 20, 2023 | |||
 | Dominic Paris | 8/30/1993 | metaldisdom@gmail.com | +15619518192 | Yes, it works for me. | Never | Leave the same, no further action needed | August 7, 2024 | |
 | Allicyn Hughes | 3/18/1977 | allicyn77@comcast.net | +19545935364 | Leave the same, no further action needed | December 28, 2023 | |||
 | Tania Herrera | 3/20/1964 | tlkherrera20@hotmail.com | +13052180754 | Helps relaxes me Allows me to fall asleep and stay asleep | No | Leave the same, no further action needed | August 1, 2024 | |
 | Evan Ritsick | 12/21/1990 | ecritsick@gmail.com | +14042935380 | Leave the same, no further action needed | June 21, 2024 | |||
 | Dianne Tammany | 1/17/1977 | tammanyd@yahoo.com | +19173995673 | Tinctures work great | No | Leave the same, no further action needed | January 31, 2025 | |
 | Susan Wexler | 1/15/1969 | sue.wexler@yahoo.com | +15613743369 | Leave the same, no further action needed | June 21, 2024 | |||
 | Scott Bradley | 3/13/1987 | bradscott0712@gmail.com | +15615728958 | Helps with pain from migraines | None | Leave the same, no further action needed | January 29, 2025 | |
 | Robert Goodman | 4/6/1963 | r.goodman@mac.com | +19177443688 | Pain and reduces anxiety helps with sleep | None | Leave the same, no further action needed | January 26, 2025 | |
 | Isabella Rucci | 3/8/1994 | isabellaarucci@gmail.com | +15615457758 | Take when I wake up with migraine relieves the pain. Smoke flower and take edible at same time. | No | Leave the same, no further action needed | July 30, 2024 | |
 | Karen Busch | 7/5/1945 | kbusch113086@gmail.com | +19804283174 | Reduces stress makes me happy | No | Leave the same, no further action needed | July 15, 2024 | |
 | Arnold Monroe II | 3/19/1979 | arnoldmonroe1213@gmail.com | +15618021927 | Leave the same, no further action needed | June 26, 2024 | |||
 | Judith Sady | 8/4/1954 | jsady1@comcast.net | +16099704615 | Leave the same, no further action needed | May 30, 2024 | |||
 | Jeffrey Martin | 2/15/1958 | jmartinpersonal@yahoo.com | +15615263512 | Yes, less pain | No | Leave the same, no further action needed | January 20, 2025 | |
 | Mallory Halperin | 9/27/1958 | malstang@aol.com | +19548210084 | Leave the same, no further action needed | June 13, 2024 | |||
 | Maria Perroni De Oliveira | 4/9/1986 | maria.c.peroni@gmail.com | +19544718418 | Leave the same, no further action needed | June 14, 2024 | |||
 | Vijay Anant | 8/8/1984 | vanant84@gmail.com | +13476750634 | Tremendously helps with pain and anxiety | No | Leave the same, no further action needed | January 16, 2025 | |
 | Olivia Leisure | 9/28/1998 | olivelei17@gmail.com | +15613138653 | Have definitely seen an improvement, mostly in my quality of sleep and amount of sleep I’m able to get. | No. | Leave the same, no further action needed | January 16, 2025 | |
 | Teresa Sotoodeh Trhrani | 6/15/1958 | territ88@yahoo.com | +15618093070 | Pain helps and anxiety and depression | No | Leave the same, no further action needed | January 10, 2025 | |
 | Eliyahu Goldstein | 12/10/2000 | eliyahugoldstein12345@gmail.com | +17543038591 | Clears nightmares Reduces anxiety | No | Leave the same, no further action needed | January 8, 2025 | |
 | Mark Sickles | 7/11/1957 | mark.sickles711@gmail.com | +15615231082 | Taking gummies an hour - 1 1/2 hours before trying to sleep helps the process. Also, taking them and/or creams/gels help the chronic back pain | Occasionally doing so makes me feel stoned | Request Doctor to contact me to make changes | January 7, 2025 | |
 | Brian Kenig | 9/12/1983 | kenigbrian@gmail.com | +15615726614 | Pain relief | No | Leave the same, no further action needed | January 6, 2025 | |
 | Adrienne Elias | 4/28/1942 | aelias8574@gmail.com | +15166722947 | Calms me down | 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 |
|---|---|---|---|---|---|---|---|---|---|
 | 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 | |
 | Earl Sands | 5/21/1963 | michaelsands9mm@gmail.com | +19544059108 | Helps with pain | No | Leave the same, no further action needed | December 12, 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 |
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