Nondiscrimination Form
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  • Notice Informing Individuals About Non-discrimination and Accessibility Requirements and Nondiscrimination Statement:

  • Discrimination is Against the Law


    The Children’s Clinic of Conway and Greenbrier complies with applicable Federal civil
    rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (consistent with the scope of sex discrimination described at 45 CFR § 92.101(a)(2)). The Children’s Clinic of Conway and Greenbrier does not exclude people or treat them less favorably because of race, color, national origin, age, disability, or sex.


    The Children’s Clinic of Conway and Greenbrier

    • Provides people with disabilities reasonable modifications and free appropriate
      auxiliary aids and services to communicate effectively with us, such as:
      o Qualified sign language interpreters
      o Written information in other formats (large print, audio, accessible
      electronic formats, other formats).
    • Provides free language assistance services to people whose primary language is
      not English, which may include:
      o Qualified interpreters
      o Information written in other languages.

    If you need reasonable modifications, appropriate auxiliary aids and services, or language assistance services, contact Amy Irby, Office Manager at 501-327-6000 or Teresa Kelley, Office Manager at 501-679-6796.


    If you believe that The Children’s Clinic of Conway and Greenbrier 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: Amy Irby, Office Manager, 2505 College Ave, Conway, AR. 501-327-6000, email: ccclinic@conwaycorp.net or Teresa Kelley, Office Manager, 10 Lois Lane, Greenbrier, AR, 501-679-6796, gbchildrens@tcworks.net . You can file a grievance in person or by mail, or email. If you need help filing a grievance, Amy Irby, Office Manager or Teresa Kelley, Office Manager, 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.

  • I have read The Children's Clinic of Conway and Greenbrier's Notice of Non-Discrimination
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