Section 1557 of the ACA

Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement: Discrimination is Against the Law

Grove Family Dental and TMJ Clinic, LLC
complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  

Grove Family Dental and TMJ Clinic, LLC
does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Grove Family Dental and TMJ Clinic, LLC:

  • 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 John C Gernetzke, DDS

If you believe that Grove Family Dental and TMJ Clinic, LLC 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: 

John C Gernetzke, DDS
109 S Madison St. 
Evansville, WI 53536 
United States 
Phone: 608-882-4441 / Fax: 608-882-4967 
Email Here

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, John C Gernetzke, DDS 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 1-608-882-4441.

LUS CEEV:  Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-608-882-4441.

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 1-608-882-4441。

ACHTUNG:  Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.  Rufnummer: 1-608-882-4441.

ملاحظة: إذا كنت تتحدث تذكر اللغة، تتوفر لك خدمات المساعدة اللغوية مجانا. رقم الاستدعاء 1-608-882-4441

ВНИМАНИЕ:  Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-608-882-4441.

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-608-882-4441번으로 전화해 주십시오.

CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.  Gọi số 1-608-882-4441.

Wann du [Deitsch (Pennsylvania German / Dutch)] schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-608-882-4441.

ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົ້າພາສາ ລາວ, ການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້ທ່ານ. ໂທຣ 1-608-882-4441.

ATTENTION :  Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.  Appelez le 1-608-882-4441.

UWAGA:  Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.  Zadzwoń pod numer 1-608-882-4441.

ध्यान दें:  यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-608-882-4441 पर कॉल करें।

KUJDES:  Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë.  Telefononi në 1-608-882-4441.

PAUNAWA:  Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.  Tumawag sa 1-608-882-4441.