ATTENTION: IF YOU DO NOT SPEAK ENGLISH, LANGUAGE ASSISTANCE
SERVICES, FREE OF CHARGE, ARE AVAILABLE TO YOU.

CALL (616) 224-3636.

Nondiscrimination Statement:
Root Canal Specialists A. A. Doering Endoodntics, PLLC complies with applicable Federal civil rights laws and
does not discriminate on the basis of race, color, national origin, age, disability, or sex. Root Canal Specialists A. A.
Doering Endoodntics, PLLC does not exclude people or treat them differently because of race, color, national origin,
age, disability, or sex.
Root Canal Specialists A. A. Doering Endoodntics, PLLC will provide free aids and services to people with
disabilities to communicate effectively with us including qualified sign language interpreters, written information in
other formats (large print, audio, accessible electronic formats, other formats. Please let us know upfront prior to
your appointment date and time so these services can be provided. Without any prior knowledge, your appointment
may need to be postponed.
Root Canal Specialists A. A. Doering Endoodntics, PLLC provides free language services to people whose primary
language is not English including qualified interpreters and information written in other languages.
If you need these services, contact Civil Rights Coordinator.
If you believe that Root Canal Specialists A. A. Doering Endoodntics, PLLC 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: Civil Rights Coordinator, 655 Kenmoor Ave SE, Ste #102, Grand Rapids, MI 49546, Phone (616)
224-3636, Fax (616) 224-3644, or E-mail: dr.arthur.doering@gmail.com. You can file a grievance in person or by
mail, fax, or email. If you need help filing a grievance, 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:
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf Portal, available, 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

1019-368-(800), 7697-537-(800) (TDD) Complaint forms are available at
http://www.hhs.gov/ocr/office/file/index.htm