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ETHICS AND DISCIPLINARY REVIEW

National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM®)
2001 K Street NW, 3rd Floor North
Washington DC, 20006
Phone: (888) 381-1140
Fax: (202) 381-1141
E-mail: [email protected]

Complaint Form for Professional Ethics Violation

Complainant Information

  • Complaint Information

  • Who or what agency/organization do you believe committed this violation?

  • Please attach a clear and concise description of the nature of your complaint (complaint letter), include facts, reports, dates, court documents, legal documents, medical documents and any other documents that will support your complaint:
    Drop files here or
    Accepted file types: jpg, gif, png, pdf, Max. file size: 128 MB.
    • If not, please file a complaint and attach copy of the complaint report:
      Drop files here or
      Max. file size: 128 MB.
      • AUTHORIZATION FOR RELEASE

        I understand that signing this authorization is voluntary. I understand that the release of these records and this information is for the purpose of investigation and proceedings involving issues relating to the complaint I have submitted to the National Certification Commission of Acupuncture and Oriental Medicine. I also consent to the release of these records to the State Board of Acupuncture or other regulatory agency as appropriate for use in an investigation or proceeding against the practitioner who is the subject of my complaint. I further consent to the use of these records in a criminal investigation or proceeding by any law enforcement agency against the practitioner who is the subject of my complaint.

      • I hereby attest that the foregoing information is true to the best of my knowledge and belief, and that I am competent to make these statements.

      • MM slash DD slash YYYY
      • The NCCAOM® Professional Ethics and Disciplinary Committee (PEDC) has the authority to investigate complaints received and to impose sanctions on NCCAOM® Diplomates. Please refer to the NCCAOM® Procedures for Upholding Professional Conduct to understand the process and timeline for evaluating complaints received against NCCAOM® Diplomates.

      • If you have questions about the complaint process, contact NCCAOM’s Professional Ethics Department either by phone (888) 381-1140 or by email at [email protected].