Controlled Substance Protocol

Effective 01/01/2022

Patient Name(Required)
Please read carefully, as this is a legal document. At the time of your visit:
  1. Each patient’s history will be reviewed by the provider. When it is identified that a patient is already on a controlled substance or asks for a controlled substance during the visit; the EFORCSE, Florida Prescription Drug Monitoring Program/tracking report will be pulled from the database and individually reviewed.
  2. A new patient with a history of a controlled substance will have their urine tested on the first appointment for a baseline drug screening. This will be reviewed with the patient during their appointment.
  3. If it is decided by the provider to issue any Rx for a controlled substance on the next appointment, the patient will either be required to take a saliva drug swab or a urine sample for analysis of compliance.
  4. State law now requires that a patient's urine is tested a minimum of eight times annually. This means that the testing can be done at any follow up appointment, at the time of refill, or randomly,as deemed appropriate by the provider.
  5. During each follow up appointment, the patient on Schedule II or III medications must bring the bottle and any medication remaining to the visit.
  6. Random pill counts and urine drug screening may be done to monitor compliance; patients will have four hours from the time of notification to arrive at the office with their medication.
  7. We are not a chronic pain management center, and as such, we will not dispense large amounts of pain medications. If you have chronic pain, you will be referred to pain management.
  8. Patients will read and comply with non opioid pain management options included in OPIOID REMS.
  9. Refusal to complete any part of this policy can result in the cessation of the medications and/or termination from the practice.
The following was reviewed with the patient and agreed upon:
Clear Signature
Please Intial
Clear Signature
Please Initial
Clear Signature
Please Initial
Clear Signature
Please Initial
Clear Signature
Please Initial
Clear Signature
Please Initial
Clear Signature
Please Initial
Clear Signature
Please Initial
Clear Signature
Clear Signature
Clear Signature

Controlled Substance Policy Agreement: Patient and Provider Responsibilities

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

This will close in 0 seconds

Hormone Consultation Therapy (St. Petersburg)


This will close in 0 seconds

Weight Loss (Semetaglutide | Wegovy | Monjaro) (St. Petersburg)


This will close in 0 seconds

IV Therapy (Myers Cocktail | Immunity Boost) (St. Petersburg)


This will close in 0 seconds

CO₂ DEKA TETRA | CO₂ Laser CoolPeel™ (St. Petersburg)


This will close in 0 seconds

Book Appointment at St. Petersburg


This will close in 0 seconds

Book Appointment at Brooksville


This will close in 0 seconds

Derma Filler at Brooksville


This will close in 0 seconds

Botox at Brooksville


This will close in 0 seconds

Weight Loss (Injectable GLP-1 at Brooksville)


This will close in 0 seconds

HRT Testosterone at Brooksville


This will close in 0 seconds

Book Appointment at Port Richey


This will close in 0 seconds

HRT Testosterone at Port Richey


This will close in 0 seconds

Weight Loss (Injectable GLP-1 at Port Richey)


This will close in 0 seconds

IV Therapy (Myers Cocktail | Immunity Boost) (Port Richey)


This will close in 0 seconds

IV Therapy (Myers Cocktail | Immunity Boost) (Port Richey)


This will close in 0 seconds

Book Appointment at Spring Hill


This will close in 0 seconds

HRT at Spring Hill


This will close in 0 seconds

Weight-Loss at Spring Hill


This will close in 0 seconds

Botox at Spring Hill


This will close in 0 seconds

Filler at Spring Hill


This will close in 0 seconds

Book Appointment at Weeki Wachee


This will close in 0 seconds

Filler at Weeki Wachee


This will close in 0 seconds

Botox at Weeki Wachee


This will close in 0 seconds

Weight-Loss at Weeki Wachee


This will close in 0 seconds

HRT at Weeki Wachee


This will close in 0 seconds

Copy - Book Appointment at Brooksville


This will close in 0 seconds