Discrimination is Against the Law
Gallup Children’s Dentistry complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Gallup Children’s Dentistry does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Gallup Children’s 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, other 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 the Front Office Manager.
If you believe that Gallup Children’s 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: Heather Slack, Civil Rights Coordinator, 9201 Eagle Ranch Rd NW, Albuquerque, NM 87114, (505) 892-9010, Fax – (505) 890-2949, email@example.com. You can file a grievance in person or by mail, fax, or email. You may also contact the Civil Rights Coordinator if you need help filing a grievance.
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.