DISCRIMINATION IS AGAINST THE LAW
Rock Valley Dental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Rock Valley Dental does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
ROCK VALLEY DENTAL
• Provides free aids and services to people with disabilities to communicate effectively with us,
? 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 Dr. Samuel Koth.
If you believe that Rock Valley Dental 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 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, 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.