Notice of Nondiscrimination
Appendix A to Part 92—Sample Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Sample Nondiscrimination Statement:
Discrimination is Against the Law
Ayres Chiropractic & Sports Injury Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. [Name of covered entity] does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Ayres Chiropractic & Sports Injury Center:
- 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, other formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact Dr. Thomas Ayres
If you believe that Ayres Chiropractic & Sports Injury Center 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:
Dr. Thomas Ayres
6837 Falls of Neuse Rd
North Raleigh, NC 27615
P: (919) 846-0100
F: (919) 846-3695
ayreschiro@gmail.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Dr. Thomas Ayres, Chiropractor 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.
Have a disability? Speak a language other than English? Call to get help for free.
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Èske w pale kreyòl ayisyen? Èske w andikape? Rele nou pou w jwenn èd gratis.
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Você fala potuguês? Tem alguma deficiência? Telefone para obter assistência.
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한국어 통역이 필요하세요? 장애가 있나요? 전화하시면 무료로 도와드립니다.
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ت ماس رای گان ک مک دری اف ت ب رای ه س ت ید؟ م ع لول یت دارای ک ن ید؟ یم صح بت ف ار یس زب ان ب ه ب گ ریی د