Notice of Privacy Practices
Feel free to read and/or download a copy of the West Yavapai Guidance Clinic Notice of Privacy Practices
Are you preparing for your intake/first appointment with us? These WYGC documents may be helpful as you prepare for the appointment. Read ahead and/or print and bring with you:
- Acknowledgement of Receipt of Privacy Practices
- Conditions of Admission/Consent to Treat
- Overview of Intake/First Appointment Process
- Part A Questionnaire
- Client Rights & Responsibilities Form
- Demographics Form
Spanish version WYGC documents:
If information is needed in another language, contact 928-445-5211×1. Para información en Español llame: Pamela K. Pierce, 928-445-5211×3671.
Information on Title VI Rights:
West Yavapai Guidance Clinic operates its programs and services without regard to race, color, national origin or disability in accordance with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990 (ADA). Any person who believes she or he has been aggrieved by any unlawful discriminatory practice under Title VI may file a complaint with West Yavapai Guidance Clinic.
For more information on West Yavapai Guidance Clinic’s civil rights program, and the procedures to file a complaint, contact Pamela K. Pierce:
Phone: 928-445-5211×3671 AZ Relay TTY System: 1-800-367-8939
A complainant may file a complaint directly with the Arizona Department of Transportation (ADOT) or the Federal Transit Administration (FTA) by filing a complaint directly with the corresponding offices of Civil Rights: ADOT: ATTN: Title VI Program Manager 206 S. 17TH Ave MD 155A RM: 183 Phoenix AZ, 85007 FTA: ATTN: Title VI Program Coordinator, East Building, 5th Floor-TCR 1200 New Jersey Ave., SE Washington DC 20590