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Nondiscrimination Policy

OCR NOTICE OF NONDISCRIMINATION

Source: HHS Office for Civil Rights

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

West Michigan Pediatric Dentistry does not exclude people or treat them differently because of race, color, national origin, age,
disability, or sex.

West Michigan Pediatric 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)

• 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 WMPD Manager.

If you believe that West Michigan Pediatric Dentistry 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:

Bob Poll
844 South Washington Ave. Holland, Michigan 49423
Phone: 616-392-2381
Fax: 616-392-3748
bobp@westmipeddent.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, WMPD Manager 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.