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I understand that Dr./PA-C/ARNP (hereinafter referred to as “provider”) is prescribing a controlled substance medication for pain management. This Controlled Substance Medication Agreement is a tool for communication, allowing me to work together with my provider in good faith and for me to understand the importance of this medication. In prescribing a controlled substance medication, my provider is trying to create the best treatment plan for my improvement and management of pain. This requires cooperation, trust and mutual respect. If I cannot agree with the following terms, no controlled pain medications will be prescribed. The failure to follow all terms of this Agreement will result in discontinuing the pain medication and/or dismissal from this orthopedic practice.
“Love Dr. Jones. Have come to see him since they were in the little office where the bank is now. And Kay is a fantastic receptionist. Always so acknowledgeable and so friendly. Five Star Review