Established MOUD Patients
Monthly Pre-Visit Form
Monthly patients are seen every 28 days (monthly)
$25 Standard Fee Adjustment
Early Completion Discount Available: MOUD (buprenorphine) visit fees increased by $25 starting 4/27/2026; however, a $25 discount is applied when the Pre-Visit form and payment are completed at least 24 hours in advance. Both steps can be completed up to one week early.

Quarterly Pre-Visit Form
Quarterly Patients are seen every 84 days (3 months)
$25 Standard Fee Adjustment
Early Completion Discount Available: MOUD (buprenorphine) visit fees increased by $25 starting 4/27/2026; however, a $25 discount is applied when the Pre-Visit form and payment are completed at least 24 hours in advance. Both steps can be completed up to one week early.

42 CFR Part 2
HIPAA Authorization
Patient Payment Portal
$25 Standard Fee Adjustment

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
 
Medical Patients
General Consent to Treatment
Controlled Medication Treatment Agreement