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CONTROLLED SUBSTANCE AGREEMENT

CONTROLLED SUBSTANCE AGREEMENTThis AGREEMENT relates to my use of CONTROLLED substances for chronic pain prescribed by aprovider at Valley Pain Specialists, I have been informed and understand the policiesregarding the use of CONTROLLED substances that are followed by the staff at Valley PainSpecialists. I understand that I will be provided CONTROLLED substances while activelyparticipating in this programonly if I adhere to the following conditions:1.) I will use the substances only as directed by Valley Pain ) I will not receive replacement medications that I have lost or have been ) I understand that I amresponsible for the medication and prescriptions used in mytreatment.

CONTROLLED SUBSTANCE AGREEMENT This agreement relates to my use of controlled substances for chronic pain prescribed …

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