Non-discrimination Notice

• Free aids and services to people with disabilities so they can communicate with us, such as qualified sign language interpreters and written information in other formats (large print, accessible electronic formats). One of our dentists signs in ASL.
• Free language assistance services to people whose primary language is not English, such as qualified interpreters and information written in other languages. One of our dentists speaks Spanish.

To ask for these services, call (704) 555-0129 (demo number) or tell the front desk.

ATTENTION: If you speak a language other than English, free language assistance services are available to you. Call (704) 555-0129.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (704) 555-0129.

Demo site: a real practice that receives federal financial assistance posts this notice in English and the 15 languages most spoken in North Carolina by people with limited English, translated by a qualified translator.

You can file a grievance with our civil rights coordinator in person, by mail or by phone at (704) 555-0129 (demo number). If you need help filing, the coordinator will help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal at ocrportal.hhs.gov, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at hhs.gov/ocr/office/file.