Resource Center: Consent

This is a sample of a consent form that can be used when initiating buprenorphine treatment for a new patient.

This is a patient handout to inform patients about their rights when undergoing office-based buprenorphine treatment.

This patient handout explains how consent and confidentiality are respected as a part of drug treatment.

This consent form informs the patient of the limited amount of research and knowledge currently available regarding buprenorphine use during pregnancy, and acknowledges that risks related to such use may exist, but are not yet known.

Four-page document discussing treatment of pregnant patients with buprenorphine.

Patient contract that can be used to set expectations and guidelines before beginning buprenorphine treatment.

This patient consent form (in Word®) explains buprenorphine treatment and warns about the adverse effects of mixing buprenorphine with other medications. The section at the bottom is for the patient and a witness to sign and date, indicating that the patient understands and wishes to receive treatment.

The California Society of Addiction Medicine (CSAM) website provides information and materials for buprenorphine treatment providers, including screening tools and sample consent and patient agreement forms, and provides links to other helpful resources.

This appendix from TAP 13: Confidentiality of Patient Records for Alcohol and Other Drug Treatment provides sample consent forms for substance abuse patients.

Guidance on the legal rights of individuals with alcohol and drug problems to help patients understand how they are protected from discrimination.