Clinic Report Form

We are not accepting clinic reports at this time. Our new clinic report database is installed and we hope to be accepting reports by May. Our new system will enable us to put your reports online much sooner. If you have an urgent problem, please email us at A.T. Watchdog or post to the Watchdog Message Board. Thank you for your patience.

No Computer?
Please print copies of the Watchdog Clinic Report Form and distribute to patients at your clinic. For the price of a postage stamp, MMT patients without computer access can have their reports posted on the Watchdog site and included in our growing database of clinic reports.

How-To Guide

To submit a report about your clinic, please fill out information below. If you choose to remain anonymous because divulging your identity might affect your treatment, please use a valid e-mail address so that we may contact you privately. An automatic confirmation message will be sent to the email address you give us. Your e-mail address will not be available to anyone other than the administrators of this site. All reports received will be posted online, unless you specify otherwise. By exposing clinic abuses on the Internet, we hope to create change in the present MMTP system. We also post information about good treatment programs to act as a model of what a good clinic can be, and to encourage other OTPs to improve treatment.

For more information on how to follow through with a clinic complaint, we have provided a detailed step-by-step guide of how to wade through the bureaucracy of the MMTP system in the U.S. The guide can be found here. We have also included a Printable Clinic Report Form. Please consider printing copies to distribute to MMT patients that don't have access to a computer. A mailing address for Methadone Watchdog is provided. Reports will be posted to this site.

All reports must have a valid email address or they will not be processed! If you don't see a report you have submitted, it's probably because a valid email address was not used. Because staff time is limited, reports submitted that use all capital letters will not be posted. It's too time-consuming for us to re-type all the information. Please use spellcheck. Thanks.

Your Name

Your E-Mail Address

Do you wish to remain anonymous? All reports submitted to Watchdog must have a valid email address.

Yes
No

How long have you attended this clinic?
Years
Months

Clinic Name

Street Address

Clinic City

Clinic State

Clinic Contact Name

Clinic Email Address (if available)

What is the weekly rate at your clinic?
$

Is your clinic privately owned?
Yes
No

Does your clinic have a waiting list?
Yes
No

Does your clinic have a dose cap? (or are takehomes limited due to amount of dose?)
Yes
No

Is group counseling mandatory at your clinic?
Yes
No

Does your clinic have an emergency plan in effect?
Yes
No

Is clinic staff on call at ALL times?
Yes
No

Does your clinic have a policy of observed UAs?
Yes
No

What is the average waiting time for dosing?

Does clinic offer Hep C testing or referral?
Yes
No

Please make a brief comment. Additional space has been added to tell us about specific incidents that may not be appropriate for posting on the reports site. Because of space limitations, we can only allow one or two paragraph comments in our comment section. Please give information about your clinic that a new patient would find useful. If you feel your clinic is one of the good ones, please let others know about it. Providers that offer their patients quality treatment should be recognized. Comments will be edited for length. Clinic staff will not be mentioned by name.

Unless appropriate, individual incidents won't be posted on the website. We would like to hear your stories, and the information you send us will be forwarded to officials if you give us the OK. Information included in the second text box will be included in the Watchdog database, but will not be posted on the site.

If you have a story to tell about your clinic, please submit it for posting on the Stories page.

Please use this area to submit a longer version of your clinic report for posting on the 'Clinic Stories section of Watchdog. Staff names will not be used. Please let us know if you wish to remain anonymous. Stories will be edited.

Please use your back button to return to this page after submitting your report form. Thanks.

The more we expose clinic abuse, the closer we come to making a change in our present system of MMTP. Please go to the Resources page to find email addresses of organizations and agencies that need to be made aware of the abuse that we are made to endure because of our choice of treatment. Links to methadone organizations and government officials are provided for reference. Please consult our How-To Guide for suggestions on resolving your problem. If you have additional questions, please post to the Watchdog Message Board.

We have provided a Clinic Report Form that can be printed by our readers to give to MMT patients that don't have access to a computer. All clinic reports received will be posted to the Methadone Watchdog site. A mailing address is provided. The printable version of the report by clicking this link. Please distribute these forms to other patients at your clinic. The more reports we post about our clinics, the closer we get to making meaningful changes. Thank you.

Please distribute the printable version of the
Clinic Report Form
at your clinic.

Go to the How-To Guide

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