Notice of Non-Discrimination

This Dental Office complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. This Dental Office does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.

This Dental Office:

• Provides free aids and services to people with disabilities to communicate effectively
  with us, such as:
  • Qualified sign language interpreters
  • Written information in other formats (large print, audio, accessible electronic
    formats, other formats).

• Provides free language services to people whose primary language is not English,
  such as:
  • Qualified interpreters
  • Information written in other languages

If you need these services – contact this Dental Office

If you believe that this Dental Office has failed to provide these services or discriminated in
another way on the basis of race, color, national origin, age, disability or sex, you can file a
grievance with the U.S. Department of Health and Human Services, Office of Civil Rights,
electronically through the Office for Civil Rights Complaint Portal, available at;
http://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509 F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html

This notice is based on a standard notice provided by the U.S. Department of Health and Human Services, Office for Civil Rights and is required under the Section 1557 of the Affordable Care Act.