Patient Forms

Random Drug Screens: Agree to complete drug screens within 24 hours when requested.
Monthly Appointments: Controlled substances require monthly visits unless otherwise specified by your provider.
Single Provider Policy: Do not seek controlled medications from other providers or pharmacies.
No Early Refills: Manage your medication supply to align with scheduled appointments.
Electronic Prescriptions: Prescriptions will be electronically sent to your chosen pharmacy.
Monitoring: Prescription tracking systems are used to ensure compliance.
Efforts to Reduce Use: Work toward reducing reliance on controlled substances by engaging in alternative therapies such as Cognitive Behavioral Therapy (CBT) or biofeedback.
Withdrawal Management: Seek emergency care for withdrawal symptoms, as West Valley Health Equity cannot provide immediate crisis services.

For your convinience our forms can be filled out online, simply click the links below. You can complete these patient forms in advance from the confort of your home, or complete at check-in.