ACA NOTICE

ACA Notice- Section 1557

ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call (616) 895-7199.

 

Meade Zolman Family Dentistry PC

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

 

Meade Zolman Family Dentistry PC

Does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

 

Meade Zolman Family Dentistry PC:

- 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 Roxanne Heathman.

If you believe that Meade Family Dentistry PC 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:

 

Roxanne Heathman, Civil Right Coordinator

11301 Commerce Rd, Allendale, MI 49401

Phone: 616-895-7199

Fax: 616-895-5698

office@smileallendale.com

 

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Roxanne Heathman 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, DC 20201

Toll Free: 1-800-868-1019,

800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.