Become A Patient


Appendix A to Part 92—Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement:

Discrimination is Against the Law

Centurion Spine & Pain Centers complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Centurion Spine & Pain Centers  does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Centurion Spine & Pain Centers:

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

If you need these services, contact Leslie Faulk, HR Manager

If you believe that Centurion Spine & Pain Centers 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:

Leslie Faulk, HR Manager

10475 Centurion Pkwy N Suite 201, Jacksonville, FL 32256

904-256-2736, or email

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Leslie Faulk, HR 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:, 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

Appendix B to Part 92—Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 904-294-4834

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 904-294-4834

ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 904-294-4834

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 904-294-4834

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 904-294-4834

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 있습니다. 904-294-4834번으로 전화해 주십시오.

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 904-294-4834

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 904-294-4834

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 904-294-4834

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 904-294-4834

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 904-294-4834

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 904-294-4834

ةظوحلم:إ ك اذ ت تن ا ثدحت ا ركذ ف ،ةغلل خ نإ ا تامد ا ةدعاسمل ت ةیوغلل ل رفاوت ب ك ناجملا.ا ب لصت مقر1-904-294-4834 ) ر مق. 904-294-4834 : ا مكبلاو ھ مصل

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。904-294-4834 まで、お電話にてご連絡ください。

s ت ھجو:ا ب رگ ز ھ ف ناب گ یسرا م وگتف ک ی ت ،دین ز تالیھس ب یناب ر تروص ب ناگیا ش یار ام. دیریگب ت سام904-294-4834  ب ا.ب م دشا ف ی