A Notice of Nondiscrimination
November. 10. 2016
source: HHS Office for Civil Rights
University Square 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.
University Square Dental Associates does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
University Square Dental Associates:
- 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).
- Qualified interpreters
- Information written in other languages
If you need these services, contact Jocelyn Samuels, Director.
If you believe that University Square 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:
Jocelyn Samuels, Director
U.S. Department of Health & Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievnace, Jocelyn Samuels, Director 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, DC 20201
Toll Free: 1-800-868-1019, 800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.