Notice of Nondiscrimination. It is Against the Law to Discriminate
Dr. K’s Pediatric Dentistry complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Dr. K’s Pediatric Dentistry does not exclude people or treat them differently because of race, color, national origin, age, or sex.
Dr. K’s Pediatric Dentistry:
1. 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)
2. Provides free language services to people whose primary language is not English, such as:
- Information written in other languages
If you need these services, please contact our Civil Rights Coordinator.
If you believe that Dr. K’s Pediatric 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 our Civil Rights Coordinator, 125 W Evergreen Ave, #204, Palmer, AK, 99645, ph. (907) 745-5437, fax (907) 745-5457, email firstname.lastname@example.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: US Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, 1-800-868-1019, 800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office.file/index.html