Addiction Medicine Services

100 Kingsway East, Building D  Suite 3, Sewell, NJ 08080  856-589-1440  856-589-4616 (fax)

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Forms You May Need for Your First Visit

It is advisable to review consent forms before coming to the office for your first visit.  You will be asked to sign consent forms at that time.  Often patients forget questions when they arrive at a doctor's office.  We encourage you to write your questions and bring them to your first visit. 

• Consent for Medical Treatment-  Required of all new patients.

• Opiate Detoxification Form- Review this form if you seek detoxification from opiates, but not ongoing buprenorphine treatment.

• Pain Management Agreement-  Review this form if you intend to receive opiate medications for chronic pain treatment. Patients who know they want to be treated with methadone for pain need to review the specific methadone patient information sheet.

• Buprenorphine Treatment Agreement- Review this form if are to receive buprenorphine (Suboxone) treatment for opiate dependence.

Our Privacy Policy

• HIPAA Notice of Privacy-  This is information provided to you as required by law. It applies to all of our patients. You do not have to bring a copy to the office.

 Patient-Administered Psychiatric Screening Tests* Recommended Before First Visit

• Bipolar Disorder Screening Form- Patient with Bipolar Disorder (Manic Depressive) are at increased risk for addiction.

• Obsessive-Compulsive Disorder Screening Form- Many patients with addiction suffer in silence with this disorder, never telling their doctors out of embarrassment.

• ADHD Screening Form- Patients with ADHD are at increased risk for addiction.

• Depression Screening Form- Untreated depression often leads to drug addiction relapse. Depression also increases chronic pain.

• Anxiety Screening Form- Anxiety can be treated with counseling and/or medication.

• Post Traumatic Stress Disorder (PTSD) Screening Form- Patients who suffered traumatic events in childhood or adulthood may suffer from this disorder; untreated it can add to emotional and physical suffering.

• Alcoholism Screening Test- A brief test to let you know if you are likely a problem drinker.

• Substance Abuse Screening Test- A test to help you determine if you might be an addict.

• Readiness to Change Questionnaire- Are you ready to change your life?

*These are "public domain" questionnaires available on the Internet