Notice of Nondiscrimination
Discrimination is Against the Law
Piedmont Dental Associates complies with applicable Federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability, or sex. Piedmont Dental Associates does not
exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Piedmont Dental Associates:
•Provides free aids and services to people with disabilities to communicate effectively
with us, such as qualified sign language interpreters and written information in other formats; and
•Provides free language services to people whose primary language is not English, such as qualified
interpreters and information written in other languages.
If you need these services, contact Pattie Bumgarner, Civil Rights Coordinator, of our staff.
If you believe that Piedmont Dental Associates 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 Pattie Bumgarner Civil Rights Coordinator, 181 W. Wilkes Medical Center Rd., Ferguson, NC
28624, (phone) 1-336- 973-5060, (fax) 1-336- 973-5150, (email) email@example.com.
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Pattie
Bumgarner 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.