Clinic Policy

---

 Welcome to Anjuna Sports Acupuncture in Eugene, Oregon! Our team is dedicated to providing caring and efficient treatments. To ensure the best experience for all our patients, please review the following guidelines: 

 We strive to run on time for every patient. Occasionally, unforeseen circumstances may cause delays, and we apologize in advance if this affects your appointment. Your prompt arrival helps us maintain our schedule. If you are more than 10 minutes late, we may need to provide a shortened treatment or reschedule your appointment to ensure you receive the quality care you deserve. This decision will be at the clinic's discretion, and you will be responsible for the No Show fee. 

 We understand that situations may arise preventing you from keeping an appointment. While 48 hours' notice is preferred, we require at least 24 hours' notice for cancellations. Cancellations without proper notice (via phone call or electronic message) will incur the No Show fee, which is not covered by insurance. This balance must be paid before your next appointment. If cancellations occur repeatedly, you may be limited to 'walk-in' or same-day appointments until further notice. 

 Your first visit will last approximately 45–55 minutes. Please eat within 1–2 hours before your appointment and wear loose, comfortable clothing. We ask that you arrive 15 minutes early to complete any necessary paperwork. Alternatively, you can complete the new patient forms online via the Patient Portal using the link sent upon booking. Self-pay patients can pay by cash, check, or card. 

All new insurance patients will be charged the cash rate until their first insurance claims fully processes. During the start of the calendar year, or your insurance plan year, plans will be billed accordingly, and patients are responsible for paying any copay, co-insurance, or deductible within thirty days of service. Most patients should expect to pay all or a portion of their deductible at the start of the calendar or plan year.

A 1.5% interest fee will be applied to all bills over thirty days old. Unpaid bills greater than 180 days will be reported to collections agencies. Anjuna Sports Acupuncture does not extend credit to clients. 

• A list of your current medications and supplements, including dosages. 

• Relevant medical records, such as x-rays, lab work, or other diagnostic studies. 

• Any additional information that may assist us in providing optimal care. 

 Our current rates can be found on our booking portal via our website. 

 We accept and bill insurance as a courtesy. Alternatively, you may choose to bill your own insurance (we can provide a superbill) or pay a Time-of-Service (TOS) fee, which includes your copay, coinsurance, or deductible as determined by your insurance plan. All TOS payments are due at the time of service. 

Our staff can provide information on current insurance and billing options. You are ultimately responsible for any remaining balance after insurance coverage, including unpaid services. The clinic will rebill for a date of service only once if an error was made by our office. Please note that we do not bill secondary insurance carriers at this time. 

 I hereby request and consent to the performance of acupuncture treatments and other Oriental Medicine procedures, including various modes of physiotherapy on me (or the patient named below, for whom I am legally responsible) by Anjuna Medicine (Anjuna Sports Acupuncture) Staff, and/or other licensed acupuncturists who now or in the future treat me while working or associated with, or serving as a back-up for Anjuna, including those working at this or any other office, whether signatories to this form or not. I understand that methods of treatment may include, but are not limited to, acupuncture, moxibustion, cupping & gua sha, electrical stimulation, breathing techniques, exercise therapy Tui-Na (Chinese massage), Chinese or western herbal medicine, and nutritional counseling. I have been informed that acupuncture is a safe method of treatment, but that it may have side effects, including bruising, numbness or tingling near the needling sites that may last a few days, and dizziness or fainting. I understand that I should not make significant movements while the needles are being inserted, retained, or removed. Bruising is a common side effect of cupping and gua sha. Unusual risks of acupuncture include spontaneous miscarriage, nerve damage and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although the acupuncturist below uses sterile disposable needles and maintains a clean and safe environment. Burns and/or scarring are a potential risk of moxibustion. I understand that while this document describes the major risks of treatment other side effects and risks may occur. The herbs and nutritional supplements (which are from plant, mineral, and animal sources) that have been recommended are traditionally considered safe in the practice of Chinese medicine, although some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs are nausea, gas, stomachache, vomiting, headache, diarrhea, rashes, hives and tingling of the tongue. I understand that the herbs need to be consumed according to the instructions provided orally and in writing. I understand that some herbs may have an unpleasant taste or smell. I will immediately notify the acupuncturist of any unanticipated or unpleasant effects associated with the consumption of the herbs. I will notify the acupuncturist who is caring for me if I am or become pregnant. I do not expect the acupuncturist to be able to anticipate and explain all possible risks and complications of treatment, and I wish to rely on the acupuncturist to exercise judgment during the course of treatment which the acupuncturist thinks at the time, based upon the facts then known, is in my best interest. I understand that results are not guaranteed. 

 Massage is the physical touching of the body for the purposes of relaxation or pain relief. I acknowledge the therapist is not a physician and does not diagnose illness or disease or any other physical or mental disorder. I clearly understand massage is not a substitute for a medical examination. I understand there are other options I may seek if massage does not solve my needs. I understand no assurances or guarantees have been made to me as to the results of this treatment. I understand that, as with any treatment, there may be risks. Risks include but are not limited to: prolong position discomfort, temporary pressure pain, skin sensitivity to oils, temporary bruising from cupping therapy. I assume responsibility for those risks. I understand that the massage therapist must be fully aware of any existing medical conditions. I have completed my health intake form accurately. I also agree to keep the therapist appraised of new conditions or medications. I will tell the therapist if the pressure is too great so she or he can adjust pressure to my comfort. I authorize my therapist and Anjuna Sports Acupuncture to release or obtain information pertaining to my condition(s) and/or treatment to/from other medical providers. I have been given time to ask questions about massage treatments. 

At Anjuna Sports Acupuncture, patient privacy and clear communication are central to your care experience. We use a range of tools to share appointment reminders, billing updates, and clinically relevant information—always aiming to balance convenience with security. Our preferred channel for protected health information (PHI) is the encrypted Patient Portal, but we will also reach out by phone/voicemail, encrypted and unencrypted e‑mail, SMS/text, HIPAA‑compliant telehealth platforms, and (only at your request) social‑media direct messaging.

Email and text are popular, yet they travel over open networks that may be intercepted, mis‑addressed, or stored on cloud backups you cannot fully control. Federal privacy rules permit these methods if you are informed of the risks and still choose them. By authorizing their use, you acknowledge these vulnerabilities and agree to take reasonable precautions—such as password‑protecting your devices and notifying us promptly if they are lost or compromised.

To reduce risk, we follow a “minimum‑necessary” approach: messages contain only what is essential, we double‑check addresses before sending, and we direct sensitive documents to the secure portal whenever feasible. If you prefer to restrict any channel, simply tell our front‑desk team and we will honor your choice.

Separately, you may opt‑in to wellness tips, newsletters, workshop invitations, or promotional offers. Marketing e‑mails include a one‑click unsubscribe link, and text promotions honor “STOP” replies. We request your explicit written (or electronic) permission before sending these materials, consistent with federal e‑mail, text, and telemarketing rules.

Your consent is revocable at any time. Just call, e‑mail, send a portal message, or use the built‑in opt‑out tools. Revocation will not affect messages already sent but will take effect promptly for future communications.

Key References
1. U.S. Department of Health & Human Services. HIPAA FAQ: Does HIPAA permit health care providers to use email to discuss health issues with patients?
2. U.S. Department of Health & Human Services. E‑mailing and Texting PHI: Beware HIPAA (2025).
3. Federal Communications Commission. TCPA Consumer Consent Rules (Report & Order FCC‑24‑24, 2024).
4. Federal Trade Commission. CAN‑SPAM Act Compliance Guide for Business (2023 update).
5. Oregon Medical Board. Social Media and Electronic Communication Guidance (2024).

Age 15–17: Under ORS 109.640 the minor may consent to medical treatment (including acupuncture) without parental permission. We nevertheless request parental/guardian acknowledgment for record accuracy and billing. Under 15: Written consent must be provided by a parent or legal guardian before treatment begins. Provider may (but is not required to) notify a parent/guardian about diagnosis or treatment under ORS 109.650, unless the minor legally objects. HIPAA applies; records are confidential except as permitted or required by law.

Anjuna uses only FDA‑registered, single‑use, sterile needles and follows Clean Needle Technique and OSHA blood‑borne‑pathogen standards (29 CFR 1910.1030). All sharps are disposed of in approved bio‑hazard containers.