Common Contracts
1 similar Pain Management/Controlled Substance Agreement contracts
Metropolitan Pain Management Consultants, Inc. A Medical Group Lee T. Snook, Jr., M.D., D.A.B.P.M., F.A.C.P., F.A.S.A.M. Medical Director PAIN MANAGEMENT/CONTROLLED SUBSTANCE AGREEMENTPain Management/Controlled Substance Agreement • September 17th, 2020
I, {patient_fname} {patient_lname}, understand that the main treatment goal is to improve my ability to function and/or work. In consideration of that goal, and that I am being prescribed opioid (narcotic) medication to help me reach that goal. I agree to help myself by following better health habits, specifically involving exercise, weight control, and restricting the use of tobacco. I understand that other medical care may be prescribed to help improve my ability to perform activities of daily living and my ability to work. This may include exercise, use of non-narcotic analgesics, physical therapy, psychological counseling or other therapies or treatment. I understand that only through following a healthier lifestyle can I hope to have the most successful outcome to my treatment. I also understand that in order to receive care for the treatment of pain or the use of controlled medications, I agree to and will comply with the following:
