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Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

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Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

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Page 1: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 2: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 3: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 4: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 5: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 6: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 7: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

Page 8: Dr. Vassileva | Lawton, OK · but are not limited to xanax, valium, percocet, ultram, ambien, adderall, norco or klonopin. i have read and agree with the above: patient signature

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