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New MOUD Patients
New Patient Intake Packet
MOUD Program Eligibility Review
MOUD Treatment Agreement
General Consent to Treatment
Clinical Opiate Withdrawal Scale (COWS)
One-Week Follow-Up Pre-Visit Form
Established MOUD Patients
Pre-Visit Form
42 CFR Part 2
HIPAA Authorization
Medical Patients
General Consent to Treatment
Controlled Medication Treatment Agreement
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Schedule of our hybrid MOUD program (in-office and telemedicine visits).

Questions about forms or getting started?

Call or text 228-246-9800 or email office@theclinicat8737.com, or send us a message below about forms, paperwork, or starting treatment.

Clinical Intake Request

Please fill out the form below to start your consultation process.

Are you currently using any medications?
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