Discrimination is against the law
Chiropractic Company complies with applicable federal civil rights laws. We do not discriminate on the basis of race, color, national origin, age, disability, or sex.
We do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
[Counsel to review/complete: optional language on the scope of sex discrimination (45 CFR 92.101(a)(2)), and any religious or conscience exemption.]
Free help for people with disabilities
We provide free reasonable changes and aids so people with disabilities can communicate with us well. These include:
- Qualified sign language interpreters.
- Written information in other formats, such as large print, audio, and accessible electronic formats.
Free language help
We provide free language services to people whose first language isn’t English. These include:
- Qualified interpreters.
- Information written in other languages.
If you need these services, contact our coordinator below. You can also ask the front desk at any clinic.
Our Section 1557 Coordinator
Our coordinator helps with these services and with grievances.
[Coordinator name], [Title]Chiropractic Company
[Mailing address]
Phone: [Phone] · TTY: [TTY, if any]
Fax: [Fax] · Email: [Email]
How to file a grievance with us
Do you believe we failed to provide these services, or discriminated in another way? You can file a grievance with our coordinator.
You can file in person, or by mail, fax, or email. If you need help filing, our coordinator can help.
[Counsel to review/complete: grievance procedure details and timelines (45 CFR 92.8).]
File a complaint with the U.S. Department of Health and Human Services
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights.
- Online: OCR Complaint Portal
- Phone: 1-800-368-1019 · TDD: 800-537-7697
- Complaint forms: hhs.gov/ocr/office/file
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Language assistance
Free language help is available. The statements below tell you how to get it in your language.
[Counsel/compliance to supply: language assistance taglines in the top 15 languages spoken in Wisconsin, each in its own language, plus a large-print tagline.]