Western New York Dental Group (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. The Practice:
- 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, Michaela Waggoner at 716-634-4679 x5.
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:
Michaela Waggoner, Civil Rights Coordinator 125 Lawrence Bell Drive Williamsville, NY 14221 716-634-4679 x5 email@example.com
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 http://www.hhs.gov/ocr/office/file/index.html. Language Assistance Services - New York 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