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  • Controlled Substances Consent

    Please review the following information carefully. By signing below, you acknowledge and agree to the terms under which Alexander Medical prescribes and manages controlled substances.
  • Alexander Medical prescribes controlled substances only when medically appropriate and always in compliance with federal law, DEA requirements, and applicable state regulations. Our goal is to use these medications safely and responsibly to support your health while minimizing risks of misuse, diversion, or harm.

     

    Medications Covered

    Controlled substances prescribed at Alexander Medical may include, but are not limited to:

    • Hormone therapies (such as testosterone)
    • Stimulant medications (such as Adderall or Vyvanse)
    • Short-term use of benzodiazepines for very specific, clinically appropriate circumstances 

     Alexander Medical does not prescribe:

    • Long-term benzodiazepine therapy
    • Opioid pain medications
    • Buprenorphine/naloxone combination products (such as Suboxone)

     

    Patient Agreement and Clinic Policies

    By signing below, you acknowledge and agree to the following:

    • Controlled substances will only be prescribed for legitimate medical purposes as determined by your provider (physician, nurse practitioner, or physician assistant).
    • All prescribing and refills will follow DEA regulations, including timing and quantity limits.
    • Prescriptions will not be refilled early, replaced if lost, stolen, or damaged (including broken vials), or increased in frequency without medical justification.
    • Exceptions may be made only at the sole discretion of your provider on a case-by-case basis.
    • Evidence of suspicious medication use, diversion, or repeated early refill requests may result in modification or termination of prescribing.
    • While not required for all patients, you may be asked to undergo urine drug screening if your provider deems it necessary. Refusal may affect the continuation of controlled substance prescribing.
    • You are strictly prohibited from sharing, selling, or distributing your medication. Doing so is illegal and grounds for immediate termination of care.
    • Alexander Medical reserves the right to decline, modify, or discontinue prescribing controlled substances at any time if there are concerns about safety, misuse, non-compliance, or if therapy is no longer medically necessary.
  • ACKNOWLEDGMENT

    I have read (or had this consent form read to me) in its entirety. I have had the opportunity to ask questions, and all of my questions have been answered to my satisfaction. I understand the risks, benefits, and alternatives associated with the use of controlled substances, including the off-label use of certain therapies such as hormone treatments. I understand that these medications will be prescribed only when medically appropriate, and always in compliance with DEA regulations and applicable state laws. By signing below, I voluntarily give my informed consent to the use of controlled substances as part of my treatment plan at Alexander Medical.

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