Health history, current medications, and background we'll review before your first visit.
Download PDFExplains how Suboxone works, its risks and benefits, your alternatives, what the program asks of you, and how your privacy is protected.
Download PDFOur Wisconsin-compliant consent for virtual visits, required before any telehealth appointment.
Download PDFHow visit costs, the monthly fee, and refunds (if the program isn't a fit) work.
Download PDFHow your substance use disorder treatment records are protected under federal law, and your privacy rights. Please sign and return the last page.
Download PDFPrint the form, fill it out by hand, and text us a photo or scan:
iPhone: Notes app → camera icon → Scan Documents → text us the scan.
Android: Google Drive → the “+” button → Scan → text us the file.
No scanner handy? A regular photo works fine too.
Text a photo or scan to 414-213-1505.
No smartphone, or would rather not send it electronically? Call us and we'll take your information over the phone, then mail you a prestamped envelope to send the signed form back.
A quick note: texting a photo is convenient, but it isn't a fully secure way to send personal health information. It's completely your choice — if you'd rather use a more private method, just let us know and we'll arrange one.
Call or text us seven days a week — we're glad to walk through anything before you sign.
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