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Patient Responsibilities

By agreeing to controlled substance treatment, the patient agrees to the following terms:

  1.  Only one Provider

    • I agree to receive controlled substances only from Unwind Your Mind Psychiatry and Wellness unless referred to a specialist.​​​

  2.  One Pharmacy​

    • I will use one designated pharmacy to fill all prescriptions.​

  3.  No Early Refills​

    • I will not request early refills or claim that medication was lost or stolen. Repeated requests will be grounds for termination.​

  4. Medication Safety​

    • I will store medications securely and will not share them with others under any circumstances.​

  5. ​Follow-Up​​

    • I will attend all scheduled follow-up appointments for medication monitoring.​

  6. Drug Testing​

    • I understand that random drug tests may be conducted at any time.​

  7. Honesty​

    • I will be honest about all medication use, including supplements, cannabis, or alcohol.​

  8. Termination Clause​

    • I understand that failure to comply with any of the above may result in discontinuation of medication and/or discharge from care.​

Patient Acknowledgement

Please fill out the following form.

Date of birth
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1501 S. Ranchwood Blvd, Suite 203, Yukon, OK 73099

Tel: 405-914-6634

Fax: 405-914-6693

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