Jump to Content

Available Forms

7. FOLLOW UP Opioid Dependence Progress Report

Opioid Dependence Survey - Fill out WITHIN ONE DAY 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.
* Required field