As a participant in the Recovery Works NW Medication Assisted Treatment (MAT) program, I freely and voluntarily agree to accept this treatment agreement as follows:
- I agree to keep and be on time to all my scheduled appointments, including medical visits, groups and individual therapy. Recovery Works NW depends on our clients keeping appointments or notifying us of changes.
- If you are more than 7 minutes late for your appointment, you may be asked to reschedule.
- If you need to reschedule your appointment, we ask that you contact the office a minimum of 24 hours in advance.
- Appointments NOT canceled within 4 hours from scheduled appointment time will be counted as a NO SHOW.
- 5 no shows for medical appointments within 6 months, or 3 in a row, may result in referral to our Wait List Clinic and temporary suspension of regularly scheduled appointments. Wait List Clinics currently occur every Tuesday and Thursday at both our Tigard and Portland facilities (in-person only) from 12:30-1:30pm.
Once a client is referred to Wait List Clinic, they will only be seen by a Recovery Works NW prescriber in-person during Wait List Clinic hours. These visits are first-come, first-served. Patients referred to Wait List Clinics are guaranteed to be seen if they arrive at or prior to 1:30pm. There is no guarantee of access to a prescriber for individuals arriving to Wait List Clinic after 1:30pm. Three (3) consecutive successful Wait List Clinic visits are required before individuals are able to schedule a visit with a medical provider.
2. I agree to adhere to the payment policy outlined by this office. Those with verified insurance will pay their co-pay, co-insurance, and deductible if applicable.
Non-insured patients will pay cash payments of:
- $150.00 for initial A&D assessment (one-time fee per treatment episode)
- $205.00 for initial medical consultation (one-time fee per treatment episode)
- $150 for follow up medical appointments.
- $100 for 60-minute individual session with counselor or therapist
- $50 for 30-minute individual session with counselor or therapist
- $40 for group therapy
- $30 for basic urine drug screen
- $25 for urine toxicology confirmation
- You cannot be seen without payment.
- Please note, urine specimens are often sent to the lab for confirmatory testing and may result in additional fees
3. I have read and agree to the following terms of conduct:
- Kindness will always result in better outcomes, no matter what my concern.
- I agree to communicate kindly with Recovery Works NW staff. I will not raise my voice or behave aggressively with staff
- If I feel unheard, unkindly or unjustly treated I will use the formal grievance procedure or send a message to firstname.lastname@example.org.
- If I need an advocate, I will request to speak with a Peer
- Recovery Works NW is safe for all people.
- I agree to refrain from derogatory, defamatory or unkind language in my interactions with others whenever on Recovery Works NW property or otherwise engaged with programs
- Racist, Homophobic, Transphobic, Misogynistic, Aggressive and other unkind language and/or behavior is not tolerated within our facilities
- I am here to heal.
- I understand that talk of sourcing, selling, using or diverting drugs of abuse will not be tolerated, except in group therapy led by Recovery Works NW staff
- I understand that use of illicit drugs on Recovery Works NW property may result in immediate dismissal from programs and permeant trespass from properties
- Possession of weapons is strictly forbidden on Recovery Works NW properties.
- I understand that engaging in the above-mentioned activities may result in automatic dismissal without appeal and that Recovery Works NW reserves the right to refuse service to anyone at any time.
4. I understand that my medication is only prescribed to me at my regular office visits. If I miss my appointment, I agree to call the office immediately to discuss the situation and will be informed of potential solutions.
5. I understand that the medication I am prescribed is my responsibility, and I agree to keep it in a safe and secure place. If my medication is lost or stolen, I agree to contact the office immediately to discuss the situation and will be informed of potential solutions.
6. I agree to inform my provider about any and all medications prescribed to me by any other healthcare provider outside of Recovery Works.
7. I understand that mixing Suboxone with other medication or substances, especially benzodiazepines (i.e. Valium, Klonopin, or Xanax) or alcohol, is extremely dangerous and can result in accidental overdose or even death.
8. I agree to take my medication as prescribed by my healthcare provider, and not to alter the way I take my medication without first consulting my healthcare provider. I agree not to share or sell my medication to others. I agree not to use or obtain medication from others.
9. I agree to comply with drug screens and pill counts as part of my treatment program. If I am called or texted by Recovery Works requesting a random, I agree to come in to the clinic by the end of the business day, OR call the office by the end of the business day if I am unable to come in. I agree to bring my medication to the clinic with me for a pill count and drug screen.
10. I agree to provide urine drug screens as requested AND agree not to falsify or tamper with my drug screening test in any way. Drug screens which are positive for illicit substances DO NOT result in automatic dismissal from the program. Your healthcare provider will discuss your results with you and make recommendations to help you achieve your treatment goals.
11. I understand that my prescription length (1 week, 2 weeks, 1 month) is dependent upon my adherence to treatment guidelines, including providing appropriate UA’s when requested, showing up on time for my scheduled appointments, and maintaining courteous and respectful behavior with Recovery Works staff. I understand that my prescription length will be decreased if I am not adhering to treatment guidelines.
12. I understand that office visits are routinely conducted in person, but my healthcare provider may offer me a video appointment under certain circumstances. If I am scheduled for a video visit, I understand that I must have access to a video-capable device (computer, smartphone) with a strong and reliable internet connection in a quiet and private environment.
13. I understand that my appointments with the healthcare providers at Recovery Works NW are specifically for substance use treatment. I understand that other medical problems will need to be addressed by my primary care physician or an urgent care clinic.
14. I understand that I may be asked to sign a release/exchange of information form regarding my mental health/substance use treatment, including medical records for coordination of care purposes as may be necessary for this program.
We are grateful you’ve chosen to pursue care with us.
Our staff is committed to your wellbeing and positive experiences with Recovery Works NW. As we are also humans, there will be times when we can do better. Should you have a need that is not being met, or if there is ever anything we can do to make your experience with us better, please don’t hesitate to communicate with a staff member or send us a message at email@example.com.