Controlled-Substance Treatment Agreement
Controlled-Substance Treatment Agreement
Click the fields below to fill them out.
Complete only when requested by your provider. This agreement supports safe, coordinated treatment and does not guarantee that a controlled medication will be prescribed.
- Take medication only as prescribed and store it securely.
- Use one coordinated prescriber and pharmacy when required.
- Follow appointment, monitoring, refill, and testing requirements discussed with your provider.
- Report side effects, other prescriptions, and safety concerns promptly.