I was given this form to take home and fill out by my new Chiropractor who has a "Pain Management" doctor that visits his office on Fridays. I just had a flare-up of an L5-L6 herniated disc that has been an issue off and on for ~30 years. I have been okay for about four years on that issue, but have intermittent issues with my neck vertibre when under a lot of stress and long hours. Otherwise, I'm a tough cookie and don't take anything exept for some high BP medicine, Lipitor, vitamins and Aleve or aspirin when I get a twinge and Alegra for my allergies. Long story short, I am taking no medication for this except Aleve. I was told they might be able to give me a steroid shot or possibly a short term perscription for Flexiril (sp?) which has worked in the past to stop the spiral of muscle spasms caused by the irratated pinched nerves.

Well, when I read this agreement I was shocked by what I was being asked to sign before I even see this doctor! "Random urine, blood and breath testing at my expense"??? ... agreement that if I don't adhere to the long list of terms that the doctor will "report me to all other doctors, medical facilities and appropriate authorities"!!!

What is this all about? Should I just go to my Internal Medicine doctor at Kelsy-Seibold? All of my current persciptions are already through Medco and they won't even send me a refill for my Lipitor before my projected end of prescription date, even if I'm going out of town.

This is getting a bit scary to me ... or am I over-reacting?

Your candid responses are welcomed, but this is sounding a bit too Big Brother to me. And what are the legal implications, if any, of signing this?

Thanks in advance for any knowledgable replies.