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) piedmontdental@gmail.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)