Opioid Dependence Survey - Fill out WITHIN 24 HOURS of your appointment!
Medication and Treatment Information
For example: "1 in AM, 1/2 pill at noon, 1/2 pill in PM". Do not answer "under my tongue". Do not enter how it is prescribed. Enter how YOU take it.
eg. clonazepam, alprazolam, Adderall, Ambien, etc.