As a business you have an obligation to ensure effective communication.  The situation and the communication needs of the individual will determine which auxiliary aid will provide effective communication. Often for people who are deaf, a sign language interpreter will be needed, in which case a sign language interpreter needs to be provided unless it would be an “undue burden.” When determining undue burden and whether the practice can afford the sign language, the practice should not only consider the individual fee but consider the budget of the entire practice.