Pain Treatment AgreementPain Treatment Agreement • July 20th, 2024
Pain Treatment With Opioid Medications: Patient AgreementPain Treatment Agreement • September 1st, 2016
Pain Treatment AgreementPain Treatment Agreement • September 21st, 2016
Effective pain management requires that the patient and the clinician work together. This agreement is designed to make sure that you understand the rules we will use in your care. If you do not understand any part of this agreement, please discuss it again with your clinician. It is important that you understand that if you do not fulfill your obligations in your care, we will be less effective in helping you and may have to stop treating you altogether.
Pain Treatment AgreementPain Treatment Agreement • December 14th, 2020
Effective pain management requires that the patient and the clinician work together. This agreement is designed to make sure that you understand the rules we will use in your care. If you do not understand any part of this agreement, please discuss it again with your clinician. It is important that you understand that if you do not fulfill your obligations with your care, we will be less effective in helping you and may have to stop treating you altogether.
Pain Treatment AgreementPain Treatment Agreement • May 7th, 2024
• I will give written consent for ongoing access to my PharmaNet profile by my doctor as a condition of prescribing. PharmaNet is an important tool in ensuring opioids are used safely.
Pain Treatment AgreementPain Treatment Agreement • May 7th, 2013
I understand that by definition, chronic pain is a long term problem; therefore, I must use long term solutions, including medications that are safe for long term use, physical therapy, psychological counseling and other therapies.
Pain Treatment AgreementPain Treatment Agreement • July 22nd, 2020
This Agreement between (“Patient”) and Pain Consultants (“Doctor”) is for the purpose of establishing agreement between Doctor and Patient on clear conditions for the prescription and use of pain controlling medications prescribed by the Doctor for the Patient. Doctor and Patient agree that this Agreement is an essential factor in maintaining the trust and confidence necessary in a doctor/patient relationship.
Pain Treatment with Opioid Medications: Patient AgreementPain Treatment Agreement • February 20th, 2020
It is important that you have an understanding of the risks and responsibilities that go along with this treatment. Please read each statement and sign this agreement contract. The law requires responsible usage of prescription drugs by patients. If you accept a prescription from one of our physicians, you have agreed to receive narcotics for the treatment of your pain. If you have any questions regarding this information or the office policy regarding the prescribing of narcotics, please request clarification. By signing, you agree to follow these rules:
Pain Treatment with Opioid Medications: Patient Agreement*Pain Treatment Agreement • October 21st, 2020
Pain Treatment with Opioid Medications: Patient Agreement*Pain Treatment Agreement • March 28th, 2019
Pain Treatment with Opioid Medications: Patient AgreementPain Treatment Agreement • March 24th, 2017
This Agreement is essential to the trust and confidence necessary in a prescriber/patient relationship. My prescriber has discussed my treatment plan with me. I understand that there is a risk of psychological and/or physical dependence and addiction associated with the chronic use of controlled substances for pain. I have been told about the side effects that I may experience. My prescriber is undertaking to treat me with controlled substances for pain because:
