Treatment With Controlled Medication Agreement

When you receive testosterone therapy at Milford Med Spa, you’ll be asked to review and sign our Treatment With Controlled Medication Agreement.

This isn’t about mistrust or making things harder, it’s about protecting your health, staying compliant with medical laws, and making sure your treatment is as safe and effective as possible.

Why do I have to sign an agreement for testosterone?

Testosterone is a controlled substance. That means:

It has powerful benefits when used correctly.
It also carries real risks if misused, shared, or combined with other medications or substances.
Federal and state regulations require extra safeguards around how it is prescribed, dispensed, and monitored.

The agreement is our way of making sure you and your nurse practitioner are on the same page about:

How your medication will be prescribed
How we will monitor your safety
What is expected of you as a patient receiving a controlled medication

It’s part of ethical, evidence-based hormone care, not just for legal compliance, but because your safety always comes first.

Our priorities: safety, accountability, and partnership

When you sign the testosterone treatment agreement, you’re not just signing a “form.” You’re entering into a treatment partnership with us based on:

1. Safety first

Testosterone can affect your blood counts, cholesterol, mood, cardiovascular system, and more. When used incorrectly or combined with certain medications or substances, it can increase the risk of serious side effects.

The agreement helps ensure:

You take the medication only as prescribed
You understand potential risks of misuse, overdose, or combining it with other controlled substances
You agree to monitoring (labs, check-ins) so we can keep your treatment safe over time

2. Clear expectations around refills and appointments

Testosterone therapy is not a “set it and forget it” treatment. It requires:

Regular follow-up visits
Ongoing review of symptoms, side effects, and lab results
Adjustments to dose when needed

The agreement explains that:

Refills are done in person during scheduled appointments, not through last-minute texts, calls, or weekend messages.
You are responsible for scheduling follow-up visits before you run out of medication.
Lost or stolen prescriptions or medication may not be replaced, or will only be replaced at the next visit if appropriate.

This structure protects your safety and helps us provide consistent, high-quality care instead of crisis-based prescribing.

3. Responsible use of controlled medications

Because testosterone is a controlled substance, there are strict rules around:

Not sharing or selling your medication
Not receiving overlapping prescriptions from multiple providers
Using one pharmacy for controlled medications when possible
Informing us if you are prescribed other controlled substances (like benzodiazepines, opioids, or stimulants)

These are not just clinic rules, they are part of safe, legal prescribing practices designed to prevent:

Overdose
Dangerous drug interactions
Diversion (medications being misused by someone they were not prescribed for)

4. Honest communication and whole-person care

The agreement asks you to:

Tell us about all medications and supplements you take
Inform us if you receive a new prescription from any other provider
Allow us to communicate with other prescribers if needed
Come in for drug testing or pill counts if requested for safety monitoring

We can only give you excellent care when we have the full picture. Open communication helps us tailor treatment to your body, your goals, and your health history, and reduces the risk of complications.

5. A respectful, professional environment

We are committed to providing trauma-informed, respectful, affirming care. In return, the agreement asks that:

You treat the nurse practitioner and staff with respect at all times
You do not behave in ways that threaten staff, disrupt care, or put other patients at risk

If these boundaries are violated, the agreement explains that treatment may be discontinued. This is how we protect our team, our patients, and the integrity of our practice.

What happens if I don’t follow the agreement?

The agreement clearly states that:

“I understand that I may lose my right to treatment in this office if I break any part of this agreement.”

That doesn’t mean we’re looking for reasons to stop your treatment. Quite the opposite, we want you to succeed on therapy.

However, if there are major safety concerns, repeated violations, or behaviors that put you or others at risk, we may:

Adjust how your medication is prescribed
Require more frequent monitoring
Or, in some cases, discontinue controlled-medication treatment and/or refer you elsewhere for care

This is done thoughtfully, case by case, always with safety and ethics at the center.

How this protects you

Signing this agreement protects you by:

Making sure your care is documented, structured, and defensible
Clarifying what you can expect from us and what we expect from you
Reducing the risk of harmful interactions, side effects, or unsafe medication use
Ensuring you receive ongoing monitoring instead of one-time prescribing
Supporting a transparent, trust-based relationship with your nurse practitioner

For many patients, this kind of structure actually feels reassuring; it shows that your treatment is being taken seriously and managed thoughtfully.

Where to find the agreement

Below you will find the full text of our Treatment With Controlled Medication Agreement, which we require for all patients receiving testosterone or other controlled medications through Milford Med Spa. You’ll have the opportunity to read it carefully, ask questions, and sign it before starting or continuing testosterone therapy.

I understand and voluntarily agree that:

I will keep and be on time for all my scheduled appointments with the nurse practitioner.

I will participate in all other types of treatment that I am asked to participate in.

I will keep the medicine safe, secure, and out of the reach of children.

If the medicine is lost or stolen, I understand it will not be replaced until my next appointment and may not be replaced at all.

I will take my medication as instructed and not change the way I take it without first talking to the nurse practitioner.

I understand that controlled medications are potentially harmful and if not taken as instructed may cause dependency, breathing impairment, coma, and death.

I will not call or text between appointments, or at night or on the weekends looking for refills. I understand that prescriptions will be filled only during scheduled office visits with the nurse practitioner.

If I see another provider who gives me a controlled substance medicine (for example, a dentist, doctor from the ER or another hospital, etc.) I must bring this medicine to my next visit with the Holistic Healing Partners nurse practitioner in the original bottle, even if there are no pills left.

I will make sure I have an appointment for refills.

I will treat the providers at Holistic Healing Partners respectfully at all times. I understand that if I am disrespectful to the providers or disrupt the care of other patients my treatment will be stopped.

I will not sell this medicine or share it with others. I understand that if I do, my treatment will be stopped.

I will sign a release form to let the nurse practitioner speak to all other providers that I see for controlled medications.

I will tell the nurse practitioner all other medicines that I take and let her know right away if I have a prescription for a new medicine.

I will only use one pharmacy to get all my controlled medicines.

I will not get any controlled medicine that can be addictive such as benzodiazepines (lorazepam, klonopin, Xanax, Valium) or stimulants (Ritalin, amphetamine) or opioids (oxycodone, dilaudid, morphine) without telling the nurse practitioner before I fill that prescription. I understand that the only exception to this is if I need a controlled medication for an emergency at night or on the weekends.

I will not use illegal drugs such as heroin, cocaine, marijuana, or amphetamines. I understand that if I do, my treatment may be stopped.

If required, I will come in for drug testing and counting of my pills. I understand that I must make sure the nurse practitioner has current contact information in order to reach me, and that any missed tests will be considered positive for drugs.

I understand that I may lose my right to treatment in this office if I break any part of this agreement.