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Informed Consent & Cancellation Policy                     DECLARATION AND CONSENT TO TREATMENT

Date:_________ Patient Name:___________________________________

This is to acknowledge that I have been informed and I understand that:
Any treatment or advice provided to me as a patient of Sharon Gordon, M.Ac., Dipl.Ac., is not mutually exclusive from any treatment or advice that I may now be receiving or may in the future receive from another health care provider.
I am at liberty to seek or continue medical care from a physician, surgeon or other health care provider. All information I disclose during my consult and course of treatment with Sharon Gordon, M.Ac., Dipl.Ac. remains strictly confidential.

I agree to pay for services at the time of each treatment by either cash or check.
*Superbill arrangements can be made for your records or insurance benefit provider.

Cancellation & Rescheduling Policy:

Give me a quick call, email or text message 24 hours prior to appointment.
Day of cancellation or no-show you will be the full session fee for missing an appointment. Re-scheduling with me within a week waives the fee. Illness or emergencies will also waive the fee.

I have read, accept the terms and hereby do authorize and consent to treatment from Sharon A. Gordon, M.Ac., Dipl.Ac.

Patient Signature______________________Date:___________

Attention Veterans:

This Practice Is Now Registered with the Veterans Choice Program under Health Net

On Wednesday, May 16, 2018 The U.S. House of Representatives passed the "VA Mission Act," which is legislation to extend and reform the Veterans Choice Program to allow more private care options. Here is the latest news.

The Senate approved the legislation, 92 to 5, on Wednesday, May 23, 2018 and President Trump has indicated he will sign it into law.

The bill authorizes $5.2 billion to extend the current Veterans Choice Program for one year while the VA enacts reforms to expand private care options. Funding for the VA Choice Program was due to expire on May 31.

Here is a Link to the description of the VA Mission Act