White River Dental complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. White River Dental does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
If you need these services, contact Janet Smith at: 2380 Merchant Mile, Columbus, IN 47201. Telephone: (812) 378-5500. Email: firstname.lastname@example.org. If you believe that White River 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 Melissa Braunagel using the contact information above. You can file a grievance in person or by mail, fax, or email.
If you need help filing a grievance, Janet Smith 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.