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Vision Trends Eye Care

Nondiscrimination Statement

Vision Trends Eye Care understands that discrimination is against the law and complies with all applicable Federal and State civil rights laws. Specifically, we do not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude patients or treat them any differently based on any of these factors.

When necessary and free of charge to the patient, Vision Trends Eye Care:

• Provides aids and services to patients with disabilities when necessary to effectively communicate with them

• Provides qualified sign language interpreters for hearing impaired patients

• Provides language services to those patients who cannot effectively communicate in English. This may include qualified interpreters or written information.

If you believe Vision Trends Eye Care has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you may file a grievance with:

Dr. Larry Wilkinson
4000 Avenue I, PO Box 607
Rosenberg, TX 77471
281-342-4664
FAX: 281-232-0894
larrywilki@aol.com

You may file your grievance in person, by mail, fax or email. If you need assistance filing a grievance, Dr. Larry Wilkinson is available to assist you.

You may also file a civil rights complaint with the US Department of Health and Human Services, Office for Civil Rights two ways:

(1) Electronically through the Office of Civil Rights Complaint Portal: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

(2) By mail or phone at:

US Department of Health and Human Services
200 Independence Avenue SW Room 509F, HHH Building
Washington, DC 20201
1-800-368-1019 1-800-537-7697 (TDD)

Complaint forms are available at: http://www.hhs.gov/ocr/office/file/index.html

Vision Trends Eye Care

Individuals With Limited English Proficiency Information Regarding Language Assistance Services

ATTENTION: If you speak any of the following languages, language assistance services are available (free of charge) to you upon request.

Spanish
Vietnamese
Chinese
Korean
Arabic
Urdu
Tagalog
French
Hindi
Persian (Farsi)
German
Gujarati
Russian
Japanese
Laotian

Translation for these documents may be found at http://www.hhs.gov/civil-rights/for-individuals/section- 1557/translated-resources/index.html