Notice of Nondiscrimination

Crossoak Family Dentistry complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. W M-89 Plainwell, MI does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Crossoak Family Dentistry:

  • 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, other 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 Dr. Terry Rowland.

If you believe that W M-89 Plainwell, MI 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 Dr. Terry Rowland, Phone: 269-685-1316, (TTY 269-685-1316), Fax: , Email: [email protected]. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, 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, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

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


ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 269-685-1316 (TTY: 269-685-1316).

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 1-xxxx-xxx-xxx) رقم .(xxx-xxx-xxxx-1 :والبكم الصم ھ

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 269-685-1316 (TTY:269-685-1316)。

ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغویة تتوافر لك بالمجان. اتصل برقم 269-685-1316) رقم .(269-685-1316 :والبكم الصم ھ

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 269-685-1316 (TTY: 269-685-1316).

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 269-685-1316 (TTY: 269-685-1316).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 269-685-1316 (TTY: 269-685-1316)번으로 전화해 주십시오

লক্ষ্য করুনঃ যদি আপনি বাংলা, কথা বলতে পারেন, তাহলে নিঃখরচায় ভাষা সহায়তা পরিষেবা উপলব্ধ আছে। ফোন করুন ১-269-685-1316 (TTY: ১ 269-685-1316)।

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 269-685-1316 (TTY: 269-685-1316).

ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 269-685-1316 (TTY: 269-685-1316).

ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 269-685-1316 (TTY: 269-685-1316).

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。269-685-1316(TTY:269-685-1316)まで、お電話にてご連絡ください。

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 269-685-1316 (телетайп: 269-685-1316).

OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno. Nazovite 269-685-1316 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 269-685-1316).

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 269-685-1316 (TTY: 269-685-1316).

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