formisoft

Substance Abuse Treatment Consent Form

Asks about treatment program type, substances of concern, and medication-assisted treatment consent. Built for enrolling patients in inpatient or outpatient addiction treatment programs.

Questions
12
Pages
2
Time
about 3 min

Includes

  • E-signature
  • Consent agreement
  • Emergency contact
Use this templatePrint it instead

Your practice

Substance Abuse Treatment Consent Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Enrolling patients in inpatient or outpatient addiction treatment programs
  • Documenting consent for medication-assisted treatment with buprenorphine or methadone
  • Ensuring compliance with 42 CFR Part 2 federal confidentiality regulations
  • Recording patient acknowledgment of drug testing and program policies

Formisoft for Mental Health

What's inside

Before you publish: Add your practice-approved consent wording before publishing.

Page 1 · Your information

  1. Patient Full NameText · Required
  2. Date of BirthDate
  3. Treatment Program TypeLong Text
  4. Substances of ConcernLong Text
  5. Medication-Assisted Treatment ConsentLong Text

Page 2 · Additional details

  1. 42 CFR Part 2 Confidentiality AcknowledgedLong Text
  2. Emergency Contact NameEmergency Contact
  3. Emergency Contact PhonePhone
  4. Consent to TreatmentConsent Agreement
  5. Patient SignatureE-Signature

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Substance Abuse Treatment Consent Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

Related templates

All templates

Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Substance Abuse Treatment Consent Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

Use this template