Email UpdatesTransfer From Methadone to Buprenorphine Form
Highlights criteria and patient history for those requesting to transfer from methadone to office-based buprenorphine treatment.
Patient Form
Forms to be completed by the patient.
Opioid Treatment Agreement
Provides a sample treatment agreement that describes the patient's responsibilities as well as the risks and side effects of using opioid medications.
Sample 4 Treatment Agreement
Provides a sample consent for treatment with buprenorphine/naloxone.
Sample 3 Treatment Agreement
Provides a sample consent for treatment with buprenorphine/naloxone.
Long-Term Controlled Substances Therapy for Chronic Pain: Sample Agreement
Consent form on which patient agrees to follow policies related to long-term use of opioids because these drugs have potential for abuse or diversion.
Pharmacist Prescribed Naloxone Rescue Kit – Informed Consent Form
Gives a sample informed consent form that can be used by pharmacists dispensing naloxone rescue kits.
VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain: Sample Opioid Pain Care Agreement
Consent form on which patient acknowledges understanding and expectations of opioid therapy and agrees to adhere to agreed-upon patient behaviors.