TherapyDave^™ complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).We do not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity).

We provide free aids and services to help you communicate with us. You can ask for interpreters and/or for communications in other languages or formats such as large print. We also provide reasonable modifications for persons with disabilities.

IF you need these services, contact us at 1-541-705-4666 or the toll-free number on your member identification card before making your appointment. PacificSource members can contact the PacificSource Customer Service team for interpreter services at 1-800-431-4135 (TTY 711) or at https://pacificsource.com/medicaid/get-care/healthcare-your-language

If you believe that these services have been failed to be provided or that you have been discriminated on the basis of race, color, national origin, age, disability, or sex, you can send a complaint to:

Dave Lechnyr, LCSW
2440 Willamette St., Suite 101-C
Eugene, OR 97405

If you need help filing a complaint, contact us at 1-541-705-4666 or call the toll-free number on your member identification card.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:

Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Phone: 1-800-368-1019, 800-537-7697 (TDD)
Mail: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201

Complaint forms are available at https://www.hhs.gov/ocr/complaints/

This notice is available at https://therapydave.com/language-assistance-nondiscrimination/

The effective date of this notice is November 14, 2024