NOTICE OF NONDISCRIMINATION

Sequatchie Valley Dental Associates, PC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age or sex.

Sequatchie Valley Dental Associates, PC  does not exclude people or treat them differently because of race, color, national origin, age, disability, sexual orientation or gender identity.

If you believe that Sequatchie Valley Dental Associates, PC has failed to provide services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Kaz D Hasnani, D.M.D., Dental Director

507 Betsy Pack Drive

Jasper, TN 37347

423-942-5508

Fax: 423-942-3132

Email: [email protected]

You can file a grievance in person, by fax or by email. If you need help filing a grievance, Kaz Hasnani, DMD 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, 1-800-537-7697 (TDD)

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