Agreement on Controlled Substances TherapyControlled Substances Therapy Agreement • April 20th, 2018
The purpose of this agreement is to protect your access to controlled substances and protect our ability to prescribe for you.
CONTROLLED SUBSTANCES THERAPY AGREEMENTControlled Substances Therapy Agreement • January 3rd, 2024
The purpose of this agreement is to protect your access to controlled substances and protect our ability to prescribe to you. Certain medications for concentration, anxiety, and sleep have the potential for abuse or diversion.
Agreement on Controlled Substances Therapy for Chronic Pain TreatmentControlled Substances Therapy Agreement • March 28th, 2020
This agreement creates an understanding between me (name of patient) and Dr. Nairn, the medical director of Pain Solutions, regarding the use of controlled substances to benefit my chronic pain. The term “I” refers to the name listed above and my signature appears at the bottom of this agreement. The term providers refers to any current or future physicians or providers at Pain Solutions.
Name: DOB: Date:Controlled Substances Therapy Agreement • May 31st, 2021
The purpose of this agreement is to create an understanding regarding controlled substances (a class of medications that are regulated by State and Federal government) that may be used in the treatment of your medical condition.
