Discrimination is Against the Law
[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. [Name of covered entity] does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
[Name of covered entity]:
If you need these services, contact [Name of Civil Rights Coordinator]
If you believe that [Name of covered entity] 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: [Name and Title of Civil Rights Coordinator], [Mailing Address], [Telephone number ], [TTY number—if covered entity has one], [Fax], [Email]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, [Name and Title of Civil Rights Coordinator] 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, 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.
[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
At [name of practice], your health and the health of our staff are of the utmost importance. To ensure your health and the health of our staff, we do follow usual universal precautions in our operatories and office. Additionally, every half hour to an hour we wipe down the waiting room and common spaces with disinfectant.
For the protection of all our patients and staff due the recent outbreak of coronavirus, we are requesting the following:
If you are healthy, there’s no need to cancel your regularly scheduled dental appointment.
If you have any questions or concerns, please contact us immediately. The below links provide additional information regarding the coronavirus:
Our team will continue to monitor the situation and provide updated information when warranted. Thank you for your patronage.
Have been coming since I was young and will continue to be a patient! Cozy modern office with excellent care. If you become a patient here you will be treated like family!
I actually look forward to my visits to the dentist! Dana and Bridgette are the gentlest hygienists. I had some fillings and a crown done by Dr. Kim recently and it had been a while since I had last been numb so I was a little apprehensive. My fears were gone once I sat down. He thoroughly explained what he was going to be doing and made sure I was ok and feeling no pain every step of the way. Angel, his assistant was great too. I'm so glad to have found a place my whole family feels comfortable going and I finally don't have to drag my kids to a doctor appointment. They know getting their teeth cleaned can be fun! Keep up the good work!
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