Advanced Dental Specialists (the “Practice”) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. The Practice does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
- 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, please contact our Civil Rights Coordinator, Advanced Dental Specialists, at 414-357-2040 Ext. 5.
If you believe that the Practice 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:
Attn: Civil Rights Coordinator
PO Box 423
Germantown, WI 53022
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, our Civil Rights Coordinator 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
800 537-537-7697 (TDD)
Complaint forms are available at https://www.hhs.gov/ocr/office/file/index.html.
Language Assistance Services - Wisconsin
ATTENTION: If you speak a language listed below, language assistance services, free of charge, are available to you.
CMS, Top 15 non-English Languages by State is available at: https://www.cms.gov/CCIIO/Resources/Regulations- and-Guidance/Downloads/Appendix-A-Top-15.pdf
Translated taglines available at: https://www.hhs.gov/civil-rights/for-individuals/section-1557/translated- resources/index.html