I understand that my treatment plan may or may not include a controlled medication that may assist in symptomatic relief.
Controlled medicine can be dangerous and habit forming. These medicines must be taken only as prescribed by a doctor. Please read this consent and agreement thoroughly.
If you are in agreement and fully understand the benefits and risks of the medications, sign and date below.
I have reviewed this Informed Consent and Treatment Agreement for Controlled Substances. I understand it and continue to agree to honor the Agreement. I understand that any failure to do so may result in my discharge from this medical practice.