Highland Family Dental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Highland Family Dental does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Highland Family Dental 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). Highland Family Dental 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 Michael Leoz, Civil Rights Coordinator. If you believe that Highland Family Dental 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:

Michael Leoz, Regional Manager

Office for Civil Rights

U.S. Department of Health and Human Services

90 7th Street, Suite 4-100

San Francisco, CA 94103

Customer Response Center: (800) 368-1019

Fax: (202) 619-3818

TDD: (800) 537-7697

Email: ocrmail@hhs.gov

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Michael Leoz 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, HH 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.