Treatment and Appointment Policies

• Spravato treatment must be administered in the office under the supervision of trained healthcare professionals.
• Patients are expected to arrive on time for scheduled appointments.
• Patients should notify the office as soon as possible if they need to cancel or reschedule.
• Repeated late cancellations, missed appointments, or failure to follow office policies may result in reassessment of treatment eligibility or discontinuation of Spravato treatment.
• Treatment schedules and dosing will be determined by the treating clinician. Patients should not change the dose or frequency of Spravato without clinician approval.

Spravato REMS Compliance

Spravato is subject to a Risk Evaluation and Mitigation Strategy (REMS) designed to manage identified safety risks associated with the medication. I understand and agree that:

• Spravato must be administered in a certified healthcare setting that participates in the Spravato REMS, as applicable.
• Spravato will be administered under the direct supervision of appropriately trained healthcare professionals.
• I must remain at the treatment site for the required monitoring period following administration.
• My clinical condition, including blood pressure and level of alertness, may be assessed before and during the required observation period.
• I will not take Spravato outside of the supervised treatment setting or take additional doses unless specifically directed and administered according to the approved treatment program.
• I will follow all REMS-related instructions provided by the clinic and will provide accurate information regarding my medications, medical conditions, substance use, and other factors relevant to safe treatment.
• I understand that the clinic must comply with REMS requirements and that failure to meet required REMS conditions may result in treatment being delayed, withheld, or discontinued.
• I understand that REMS requirements may change based on applicable federal requirements, and the clinic may update its policies accordingly.

Medication and Safety Requirements

• Patients must inform the treatment team of all prescription medications, over-the-counter medications, supplements, alcohol use, and recreational substances.
• Patients should follow all pre-treatment instructions provided by the treatment team.
• Patients should not use alcohol or non-prescribed substances before treatment unless specifically discussed with and approved by the treating clinician.
• Patients should inform staff immediately if they experience concerning symptoms before, during, or after treatment.
• Blood pressure and other clinical parameters may be assessed before treatment and monitored during the required observation period.
• Patients must remain in the office for the required post-treatment monitoring period and may not leave without clearance from appropriate clinical staff.

Food and Fluid Intake

Patients should follow the clinic's instructions regarding food and fluid intake before each treatment. Failure to follow pre-treatment instructions may increase the risk of nausea, vomiting, or other adverse effects and may result in treatment being delayed or rescheduled.

Observation and Discharge

I understand that Spravato can cause sedation, dizziness, dissociation, impaired attention, judgment, and coordination. I agree to remain under clinical observation for the required monitoring period and understand that discharge is determined by the treating clinical staff.

I understand that I may not leave the office on my own if the clinical team determines that additional monitoring is necessary.

Treatment Response and Side Effects

I understand that Spravato may cause side effects, including but not limited to:

• Sleepiness or sedation
• Dizziness
• Nausea or vomiting
• Increased blood pressure
• Dissociation or altered perception
• Anxiety or feeling unusual or disconnected
• Impaired coordination or attention

I agree to report significant or unusual symptoms to the treatment team.

Controlled Substance and Medication Safety

I understand that Spravato is a controlled medication and must be administered according to applicable federal, state, and clinic requirements. I agree not to share, sell, transfer, or otherwise provide Spravato to another person.

Discontinuation of Treatment

I understand that Spravato treatment may be paused or discontinued when clinically appropriate. Reasons for discontinuation may include, but are not limited to:

• Failure to demonstrate meaningful clinical benefit or continued worsening of symptoms.
• Significant or intolerable adverse effects or safety concerns.
• Medical or psychiatric conditions that make continued treatment inappropriate.
• Failure to comply with required REMS procedures or clinic safety policies.
• Repeated missed appointments, late cancellations, or inability to maintain the required treatment schedule.
• Failure to comply with transportation or post-treatment monitoring requirements.
• Repeated refusal or inability to follow treatment instructions.
• Unauthorized use, misuse, diversion, sharing, or other inappropriate handling of Spravato.
• Failure to provide accurate or complete information necessary for safe treatment.
• Clinician determination that another treatment approach would be safer or more appropriate.
• Loss of eligibility for treatment under applicable REMS, regulatory, insurance, or clinic requirements.

The treating clinician will determine whether treatment should be continued, paused, or discontinued based on the patient's individual clinical circumstances. When appropriate, the clinician will discuss alternative treatment options and follow-up care with the patient.

I understand that discontinuation of Spravato does not mean that psychiatric care or treatment will necessarily end. Other appropriate treatment options may be recommended.

Communication and Follow-Up

I agree to maintain regular psychiatric follow-up appointments and communicate changes in my symptoms, medications, medical conditions, or substance use to my treating clinician.

I understand that Spravato treatment is one component of my overall treatment plan and that the clinician may modify, pause, or discontinue treatment based on my clinical response, safety, adherence, or other medical or psychiatric considerations.

Acknowledgment and Agreement

By signing below, I acknowledge that I have reviewed and understand the Spravato treatment office policies, including transportation, monitoring, REMS compliance, and circumstances that may result in treatment discontinuation. I agree to comply with these requirements and understand that failure to follow the policies may result in treatment being delayed, rescheduled, paused, or discontinued.

I have had the opportunity to ask questions and understand that I should contact the office if I have questions regarding these policies.

This office policy agreement is intended to supplement, not replace, the current Spravato prescribing information, Medication Guide, informed consent, REMS requirements, and applicable federal, state, and local laws and regulations.