Notice of Nondiscrimination

OCR NOTICE OF NONDISCRIMINATION

Source: HHS Office for Civil Rights

Davidson Family Dentistry

complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Davidson Family Dentistry

does not exclude people or treat them differently because of the race, color, national origin, age, disability, or sex.

Davidson Family Dentistry:

• 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)
• 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 Diane Davidson

If you believe that Davidson Family Dentistry

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:

Diane Davidson, Office Administrator

8573 Urbandale Ave.

Urbandale, IA 50322

(515) 279-3848

(515)279- 7749

diane@davidsonfamilydentistry.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Diane Davidson is available to 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, available at https://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 509F, HHH Building

Washington, DC 20201

Toll Free: 1-800-868-1019,

800-537-7697 (TDD).

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