Nondiscrimination & Language Assistance Notice

Discrimination is Against the Law

Louisburg Family Dentistry complies with applicable Federal civil rights laws and does not
discriminate on the basis of race, color, national origin, age, disability, or sex.
Our practice does not exclude people or treat them differently because of race, color,
national origin, age, disability, or sex.

Louisburg Family Dentistry Provides:

• Free aids and services to people with disabilities to communicate effectively with us,
  such as qualified sign language interpreters and written information in alternative formats.
• 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, please contact our office coordinator at
(919) 496-1100.

If you believe that we have failed to provide these services or discriminated in another way,
you can file a grievance in person, by mail, or by phone at:

Louisburg Family Dentistry
531 S. Bickett Blvd
Louisburg, NC 27549
Phone: (919) 496-1100

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,
or by mail or phone at:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Phone: 1-800-368-1019

Language Assistance Services

Español (Spanish)

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia
lingüística. Llame al (919) 496-1100.

繁體中文 (Chinese)

注意：如果您使用繁體中文，您可以免費獲得語言援助服務。
請致電 (919) 496-1100。

Tiếng Việt (Vietnamese)

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.
Gọi số (919) 496-1100.

한국어 (Korean)

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
(919) 496-1100번으로 전화해 주십시오.