HIPAA and Other Notices

Confidentiality of Patient Informaton & HIPAA Form


Siegel Chiropractic Center

Non-Discrimination Statement

Discrimination is Against the Law

Siegel Chiropractic Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Siegel Chiropractic Center does not exclude people or treat them differently because of race, color, national origin, age disability, or sex.

Siegel Chiropractic Center:

Provides free services to people with disabilities to communicate effectively with us.
Provides free language services to people whose primary language is not English.

If you need these services, contact our Practice’s Compliance Officer, Scott Siegel, D.C.

If you believe that Siegel Chiropractic 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 our Compliance Officer, Scott Siegel DC, 108 Avon Avenue, Washington, NC 27889, Phone 252 946-5101, 252 975-5101, scott@siegelchiro.com.  You can file a grievance in person or by mail, fax, or email.  If you need help filing a grievance our Compliance Officer 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.

This office provides language assistance services to our patients, free of charge, in the 15 languages listed below.  If you need language assistance, upon your arrival to our office, please advise the front desk.

Mon-Khmer, Cambodian