Consent for Urine Drug Screening in Substance Abuse Treatment

Patient Information

Full Name Date of Birth ID/Medical Record Number

Consent Statement

I acknowledge that as part of my substance abuse treatment, I may be required to provide urine specimens for drug screening. I understand that the results will be used to monitor my treatment progress and shared with my treatment providers.

I have read and understand the above information. I voluntarily give my consent for urine drug screening as part of my treatment.

Signatures

Patient Signature

Date

Witness/Staff Signature

Date