Common Contracts
1 similar Controlled Substance Agreement contracts
Controlled Substance AgreementControlled Substance Agreement • May 5th, 2022
The purpose of this agreement is to outline the conditions under which my provider at Golden Victory Medical will prescribe controlled substances. By signing this form, I acknowledge I have been informed that individuals who are prescribed certain controlled substances including, but not limited to, narcotic pain medicines, stimulants, benzodiazepines, and barbiturate sedatives, can abuse those substances or may allow abuse by others, and have some risk of developing an addictive disorder or suffering a relapse of a prior addiction. Therefore, it is necessary to observe strict rules pertaining to their use, and I agree to follow the terms and procedures described in this contract for my provider to consider prescribing or to continue prescribing controlled substances to treat my condition.
