Controlled Substance Use Agreement

You have agreed to receive a controlled substance for the treatment of your condition. It is important that you have an understanding of the risks and responsibilities that go along with this treatment. Please read and initial each statement, then sign the agreement below. If you have any questions regarding this information or the office policy regarding the prescribing of controlled substances, please request clarification.
By signing below I affirm that I have read, understand and accept all of the terms of this agreement.