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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.
“All the people we dealt with from coming in the door and going out the door was wonderful. All are very kind and caring and take time with us.