Jump to Content
 

Available Forms

0. INSTRUCTIONS FOR NEW PATIENTS

NEW PATIENTS: There are forms you need to fill out before your first visit, please see the instructions below as we treat patients with different medical needs. This is a reference page don't submit this form:

FOR PAIN TREATMENT: please fill out forms 1-5 and the NARCOTIC PRESCRIBING and NON_DISCLOSURE AGREEMENT. Do NOT fill out the Suboxone or Marijuana Forms. We will call in one business day (please note our business days are typically MWF).

For MEDICAL MARIJUANA certification: fill out forms 1-6.

FOR OPIOID DETOX OR ONGOING OPIOID USE DISORDER TREATMENT: please fill out forms 1-4 then the NON-DISCLOSURE AGREEMENT, then the 3 forms for Suboxone DONT FILL OUT THE NARCOTIC DISPENSING AGREEMENT. If you wish, you can fill out the Pain Assessment Form if you also have a history of pain that is relevant to your opioid problem.

If you need treatment for opioid misuse disorder and would like VIVITROL please fill out the Vivitrol Consent but not the Suboxone forms

PLEASE NOTE: you MUST hit the "Submit Form" button at the bottom of the form AND see a message in green indicating that the form is successfully submitted or we did not receive the form.

* Required field